Informatics: System Design Life Cycle

cost-benefit analysis

- A decision-making process in which you compare what you will sacrifice and gain by a specific action - Cost that results from an undesirable event taking place and compares it to the cost of an intervention to prevent that event to demonstrate potential savings.

process diagram: Storyboard

-a visual representation of the actions of a team, including data analysis and decisions, during the performance improvement process. -may be used to present summary reports and is also a tool used in continuous quality improvement -may include a variety of items, such as charts, diagrams, pictures, text, illustrations, statistics

The process of examine the external and internal environments for strategic planning

-both external and internal environments should be examined when performing strategic planning. -in terms of the external environment, the major item of interest would be the state of technology -Some questions to ask: >> Has the hardware and/or software been updated by the suppliers? >> Do we as an organization need to move up to the new level? >> What are our competitors or peers up to? >> Would an update in technology become a competitive advantage? In terms of internal environment, this information should be readily available through feedback from the users of the current informatics systems. In addition, any changes in business processes that require new capabilities should also be examined.

Network systems

-is a group of computers link together to increase efficiency or distribute computing power. One key reason to use a network system in a healthcare facility is related to data. Patient data must be stored for a long period and access by different functional areas within the same facility. By storing patient data in a central server (accessible to all computers connected to the network), the process is made for more efficient and reliable. Another advantage of a network system is that all users share the same software making it easier for the users to share information. In addition, network software licenses are more affordable for the company to purchase. The network software patch packages are easier to upgrade since only one upgrade to the server is required. Finally, individuals can use the network connections to perform patient consult, proofread each other's work and send electronic mail.

Non-Regression Testing

-test to determine whether the introduction of new software has the effect intended. Non regression testing is often done when a new version of software is issued.

Items needed to be evaluated during a needs assessment

1. Compatibility and connectivity of the hardware and software that will be incorporated into the system. 2. Amount of downtime required for the system testing and installation 3. Set up of the test and live environments 4. System response time and number of concurrent users. 5. User support system 6. Administration of the system 7. Security parameters of the system 8. Disaster recovery contingency plans 9. User interface and ability to retrieve reports 10. System routines used for business processes such as hospital registration, records, and billing

List the items that need to be evaluated when performing system selection in the system development lifecycle

1. Cost related to the hardware, software, and network for the new system. 2. Facts about the vendor(i.e reputation, knowledgeable staff, and financial stability). 3. System capabilities in regards to ease of use, user-friendly interface, ability to meet the organization's needs, security, expandability, and ability to interface with other systems.

Describe the information that should be gathered when conducting a site visit

1. The site's experience regarding the information system's reliability and vendor support services. 2. The amount of downtime that has occurred and the primary causes. 3. System backup procedures. 4. User experiences with the various interfaces to the system. 5. Narratives regarding any customizations to the system. 6. A log of the amount hours of training that were required 7. System security performance 8. Overall satisfaction with the system

List the vendor attributes that are important for a successful purchase and implementation experience

1. What is the companies history and financial stability? 2. Do they invest in the development of new technologies? 3. How many sites currently use the company's systems? 4. What other organizations use the system being evaluated? 5. What hardware/ networking is required for the system architecture? 6. Is the company's technology state of the art? 7. What other systems and software are compatible with the system? 8. What methods of users support are available and what is the average response time to a user support request? 9. Does the organization have any large upcoming changes for the system to adapt? 10. How does the company distribute software updates?

elements of an information system-training plan

>> A training mission statement to demonstrate the organization's commitment to the training process. >> A needs assessment (who will be trained, what will be taught, what resources are necessary, how much time will be spent, and where training will occur). >> The training modes that will be used: self-paced, on-the-job, or instructor led. >> Whether the trainers are in-hours staff or contractors. >> The amount of time needed before the staff is deemed competent >> The amount of money that will be spent on training >> The methods that will be used to determine training effectiveness

common goals relevant to strategic planning in healthcare information systems

>> Computer systems designed to support business and clinical decisions. >> Stay abreast of current technology >> Using the organization's technological innovations as a marketing tools >> To meet regulatory requirements >> To aid efficiency and overall productivity >> To improve the accuracy and dependability of patient data (especially tracking).

Important questions that should be asked when performing strategic planning for information systems

>> Is the core operating system open or closed? Can programmers access the program's actual code? >> What technology is the system built upon? >> What is the user interface? Is it user friendly? >> Does the system comply with required standards (such as HL7)? >> How easy is it to access raw data and create reports? >> How is the system performance measured? >> Can users customize their views? >> How many users can access the system simultaneously? >> Is the system upgradeable? >> Will the system reduce or eliminate paper? >> What is the timeline for implementation?

Main features of ergonomic chairs

>> The ability to adjust the height of the seat. Preferably, this should include a pneumonic adjuster that allow a customized setting rather than ratcheting mechanism. The user should be able to adjust the chair so that their thighs are parallel to the floor (with both feet flat on the floor). >> The ability to adjust seat pad front-to-back. This will allow individuals of different heights to support their legs and feel comfortable. >> The chair should have padded armrests that are adjustable for both height and width. This will prevent arm strain by providing passive support of the elbows. The forearms and hands will then be in the correct neutral position for typing. >> The chair should be able to recline to transfer some upper body weight to the backrest. >> The chair should have an adjustable back support to prevent lumbar compression.

Describe the task of the steering committee in researching a new information system

>> Verify that the project fits into the organization's goals and objectives as stated in the mission statement. >> Reach a consensus on the business requirements that the new information system needs to satisfy. >> Scan the internal environment within the organization to access where the current information system is not adequate. >> Look to the future to assess the longevity of the new system and how it can evolve evolve to meet the organizational needs for the next 3 to 5 years.

Final stages of a go-live implementation

>> establish a user support structure and its format (phone, Internet-based, etc.) >> Develop a procedure for change control regarding changes to the system and future upgrade/maintenance. >> The go-live period is a very labor-intensive period for project personnel. A work schedule (including any necessary overtime) should be created in anticipation of this expected workload. >> An implementation feedback loop for users should be created. This may consist of paper questionnaires, a dedicated phone number/email address, or a website. >> a permanent committee should be established to review request and implement changes.

FOCUS Model and PDCA

A performance improvement model Find- Identify a problem within the organization 0rganize- Identify team members with an understanding of the problem Clarify- Use brainstorming techniques to determine issues and steps in solving the problem. Uncover- Analyze to determine the reason that the problem has occurred. Start- Identify a starting point for the change process Plan - Do - Check - Act: repetitive process during FOCUS stages

Discuss the following process diagram: Clinical flow chart

A schematic representation of a process and is often used to analyze quality improvement, particularly when looking for solutions to a problem. Typically, the following symbols are used: Parallelogram: input and output (start/end) Arrow: direction of flow Diamond: conditional decision (yes/no or true/false). Circle: connectors with diverging paths with multiple arrows coming in but only one going out. A variety of other symbols may be used to indicate different functions. Flow goes from top to bottom and left to right. Flow charts help people visualize how a process is carried out and to examine a process for problems. Flow charts may also be used to plan a process before it is used. Flow charts may demonstrate critical pathways to outline treatment options or paths related to findings.

Discuss developing teaching material and resources: Help tools

A variety of help tools are available for education, including the following: 1. Learning aids: Questions, guides, maps, pictures, charts, illustrations, outlines, or diagrams can be used to support lecture or computer-based training. 2. Internet tools: These can include websites that provide specific educational content and information updates, such as the Skin Care Network at NursingCenter.com (Lippincott), and interactive websites. 3. Software applications: Software is available for training on almost every health care topic and usually includes interactivity and audiovisual presentations. Many applications are available for portable devices as well. 4. Books: Many books are now available in electronic versions, making access less expensive and more easily transported. 5. Multimedia: Compact discs, DVDs, and streaming videos combine sound and images with hardware/software to deliver educational content.

Advantages of an Expert System

Advantages of __________ - Consistent decision making - Central knowledge depository - Ability to review answers and generate reports

Describe the role of support personnel with work with healthcare information systems.

All healthcare information systems have a variety of support personnel. These are the people who work to keep the system updated and running well: 1. The Super User: A super user is an employee who has some advanced knowledge about computers 9and computer systems) and is familiar with the work done at the department level. A hospital may have a super user in each unit or department. 2. Help Desk Personnel: These are the people who answer user questions over the phone or in response to e-mail. If the problem is too difficult to work out over the phone, they may send someone to the user's location. A hospital must have a 24 hours information system help line for the users. 3. PC Specialist: A PC specialist usually has a bachelor's degree in computer science and assets with training and system setup (including upgrades). They may also install software on individual devices.

Discuss assessing ongoing training needs

Although expensive training should be completed before implementation of an information system, ongoing training needs must be assessed and training instituted. Methods of assessing needs include the following: End-user questionnaires and interviews: Determine perceptions of need and user acceptance/attitudes. Staff members often know where their training needs lie and appreciate input. Analysis of error/repairs: Note patterns of error, such as increased input errors in a single department, which suggest the need for more targeted training. This type of analysis may be the most cost-effective as it trains only those who need improved skills. Reviewing staff changes: Note new additions to staff because they may have no or little or no training in use of the system.

Repetitive Stress Injury

Any injury resulting from performing a similar motion repeatedly. In the late 1990's, there was a large increase in repetitive stress (motion) injuries reported by healthcare workers due to the increase use of computers and other electronic devices.

Discuss the following collaborative tool: Wikis

Are open databases that allow the user to access, edit, delete, or add material. Wikipedia, the online encyclopedia, is a well-known example of a wiki that is open to the public. Wikis can be open to anyone or can be restricted to specific groups of people; for example, a class may have a wiki to which students post information about a particular topic. Wikis may be designed for a narrow intent, such as for one class, or to manage content for a broad purpose, such as a program. Wikis may be designed with different levels of access so , for example, only certain people are allowed to delete or edit material. Wikis use simplified markup language (HTML, XML) on an online rich-text editor that allows WYSIWYG editing. Wikis support hyperlinks, and many wikis can include photos, videos, and audio files.

Discuss teaching strategies and methodologies: Teaching Models

Audio-visual tutorials: these are very effective for supplementary material and independent study. Independent study: this is geared towards the need of the individual who can self-pace; materials may be Internet-based or paper-based and may include audiovisual materials. Goal-focused: learners are presented with goals, and all materials and activities are aimed at achieving that goal. Guided focus: learning takes place outside a formal classroom with materials provided or recommended by the instructor. Anchored: activities are based on problem-solving in relation to realistic case scenario studies. Collaborative: learners work together to complete a learning activity. Project-based: learners develop materials (e.g., videos, websites, pamphlets) regarding a topic. Problem based: learners work in teams to solve problems. Cognitive apprenticeship: Instructors model, and learners analyze and apply processes. Simulations: learners actively participate in simulated activities. Direct instruction: This is an instructor-focused presentation. Cooperative: Small teams work together through a variety of activities to master subject, which each member responsible for self-learning and learning from others on the team.

Explain the term usability when choosing software.

Based on "user-centric" design that incorporates the interaction of the human user from the start of the design process. The success (or failure) of the design is based upon measurements such as focus groups, interviews, or questionnaires with the targeted potential users of the software. For software developers, it is important to remember to dance usability with utility. The software must be able to collect the proper input and perform its primary designed function in addition to having the best possible human interface )in terms of usability). Once the software is installed, the targeted users should also test it for usability. This should include a variety of individuals from all areas of the organization. The data collected should then be shared with the software developer for usability enhancements in future versions.

Explain training requirement for the troubleshooting of system problems

Basic troubleshooting should be taught to all users of the system. This would include re-boot procedures (for a frozen screen), changing passwords, how to properly edit data entries, and when to contact the support desk. Because every system is unique, users must learn the proper procedures to follow when problems arise. Also, learning when to report system performance (i.e., when the system is running slow or oddly) to the system administrator may help avoid a much larger problem.

Discuss the following collaborative tool: Blogs

Blogs are essentially online diaries or documents that are laid out in revers chronological order (last entry viewed first) to which a blogger can add information as desired. A blog may be maintained by one person or a group of persons with shared interests. Multi-author blogs (MABs) are becoming common. Blogs allow people to register to view the blog and to comment on entries, although they are not able to edit the blog. blogs may contain only text, but most also have images and videos as well as links to others sites blogs typically focus on one primary topic of interest, such as exercise, and some serve primarily as advertisement for companies or products. Blog-hosting services are available, although blogs can also be maintained on regular internet-hosting sites with blog software.

Implementation strategy: Parallel Implementation

Both the existing (legacy) system and new system are used concurrently; for example, when moving from paper charts to computerized record keeping, both systems are used. A timetable is usually established for phasing out the legacy system. Parallel implementation allows and users to learn the new system while still using the old system to record data. This method is usually faster than phased implementation, but slower than big bang, and tends to be the most costly, both in terms of finances and time, as users must enter data into two systems, increasing the risk of errors. However, this format does allow for evaluation of accuracy of use of the new system, as comparisons data are available in the legacy system. Parallel implementation is also, less risky in terms of system, failure, and Big Bang implementation because a backup system is essentially in place.

Advantages and disadvantages of computer based training (CBT) for information systems

CBT is more popular and efficient type of training for information systems. Advantages: >> Self-paced: The trainee can go through the material as fast or slow as they choose. >> Interactive: There is instant feedback regarding >> Availability: The training is available per the trainee's schedule. >> Modules: The training can be broken up into easily completed modules, Disadvantages: >> Construction: It takes a lot of time and labor to develop and maintain a good CBT system. >> Lack of coaching: Trainees must learn without the help of knowledgeable coaches.

Programming algorithms: Recursion

Calls on itself repeatedly until a match is made. This type of algorithm is often used in functional programming.

Explain the training material and proficiency testing involved in information system training.

Choosing the appropriate materials (both those supplied by the venter and supplementary) for information system training is a key aspect of the learning process. The material should reflect and support the operation of the live information system. The materials should be clear, concise, and targeted at the comprehension level of the trainees. In addition to the training material, job aids should be available at the trainee workstation. These job aids should be step-by-step instructions as to how to work with the new system. In addition, of critical importance in training is proficiency testing. The degree to which the trainees have absorbed the knowledge should be evaluated. There are two types of proficiency examinations: criterion referenced or norm referenced. Criterion referenced measures assess each test taker against a set correct value (this measure is the most commonly used). Norm referenced exams grade individuals directly against one another.

System Development Life Cycle (SDLC)

Consist of four phases 1. Needs Assessment- Business requirements are collected from the future users of the systems 2. System Selection- information system is selected that can meet all the gathered business requirements. 3. Implementation- system is scaled up and performance tested 4. Maintenance- a help desk is set up and the system is regularly backed-up and updated

Discuss developing informatics competencies: End-users and informatics staff

Developing informatics competencies among end-users and informatics staff requires intensive and comprehensive training and institutional support. A variety of different training procedures, such as one-on-one or instructor-led classrooms, may be used. Training should include the following: -- Policies regarding computers, including privacy issues, penalties, and failure to comply with policies -- Access policies and issues regarding misuse (e.g., viewing non authorized materials) -- Pre-implementation steps to prepare end-users for changes and to inform and educate informatics -- Basic computer literacy information -- Workflow diagrams outlining changes occurring with transition from manual to automatic systems -- Scenarios with step-by-step instructions -- Access and use of health documents, and online tutorials -- Generations of error messages, including avoidance and error corrections -- Causes of screen & system freezing and troubleshooting methods -- Elements specific to the organization's system -- Maintenance and troubleshooting for hardware and software -- Methods of information retrieval -- Managing downtimes and backup systems

Discuss developing screens for consistency and ease of use: Layout

Developing screens for consistency and ease of use requires an understanding of the basic layout and text guidelines. Headings should be placed uppermost and in the same place on subsequent screens. The eye should move in a continuous line (usually top to bottom), so images and text should not be scattered about a page but arranged in an orderly vertical display. Bright colors are distracting, and red and green should be avoided because some people may be color blind too. those colors. Complex images and illustrations are difficult to view on the screen, so simple designs are preferable. Menu and status bars should be in the same place on each screen (usually top or bottom) and should contain only essential items. Icons should be easily recognizable and consistent. Unnecessary lines on the screen, such as borders, should be avoided.

System elements to be tested: Devices

Devices include input devices, such as keyboards, mouse, microphones, stylus, WebCam, and output devices, such as terminals, printers, projectors, and screens. The informatics nurse specialist must understand the systems architecture and how all the devices are interconnected as well as how the operating systems interfaces with this devices. Other necessary information include the configuration of the individual devices and software access as well as the manner in which to add individual devices to an existing system. Different operating systems use different naming protocols for similar devices and display information about devices in different manners. Devices can be in four different states when connected to a system: Undefined: the system does not recognize the device. Defined: information about a specific device is present in the database but not available to the system. Available: information about a device is present in the database and configured to the operating system. Not available/stopped: information about the device is present in its driver, but the device is not available.

Concept of Disaster Recovery Training

Disaster recovery procedures should be taught to users in the event the system "crashes" or goes down for a period of time. It is important to have a back up plan because all information system are subject to service failures. The backup procedures should allow the user to continue to perform their assigned tasks in another independent manner (such as paper-based) while the system is down. During training, users should be taken through the back up procedures for the entire organization and for their own department or unit. Additionally, the users should be taught how to backfill the data that was captured while the system was down (once it comes back up).

List some of the devices that can be used to enhance the ergonomics of a user workstation.

Due to the danger of receptive motion stress injuries and other hazards of working with computers, designers have developed a number of ergonomic enhancement products to be used in the computer work environment. They are: Glare filters: This helps reduce eyestrain from light reflecting from a user's monitor, Negative keyboard angles: This allows the keyboard to be situated below the elbows and allows the wrists to be held at a straighter, more natural angle Document holder: This holds documents at eye level so that the user may type and enter information without moving their neck up and down. Lumbar support: This helps support the back more comfortably, and helps position the back with a proper curvature to alleviate stress. Footrest: This helps to improve posture, increase blood flow to the feet, and prevent lower back pain.

The role of the command center

During the conversion and go-live process, a command center, comprised of a director and support staff, can coordinate and monitor all operations (e.g., applications, user support, vendor support, communications, documentation, technical operations). The command center should be established as part of the preliminary plan. Three primary functions of the command center include: 1. Providing communication to all parties and evaluation intelligence regarding problems. 2. Exercising control over the process of conversion, allocating resources appropriately, and demonstrating leadership in advocating the change. 3. Coordinating all activities and maintaining documentation. Members of the command center should be in the same area or adjacent areas to allow for fast and effective communication. Vendor representatives may be at the center and at off site locations and are often critical during the go-live procedures.

Discuss developing teaching material and resources: Classroom response systems

Electronic classroom response systems (CRS) include the use of clickers to respond to questions or educational content. For example, if an instructor asks the class a question, all students can answer with the clicker, which beams responses wirelessly to a computer, so the instructor can immediately determine if the students understood the question and responded appropriately. This is especially valuable in large group where quiet students (or this in the back) may have little input into discussions. Additionally, response can be projected from the computer onto a screen and, in some cases, graphed, so that students are able to see the results of the questions visually. One major advantage to the clicker is that those who might be afraid to answer or unsure can do so privately. Students using clickers often remain more actively engaged in the learning process.

Three different types of ergonomics

Ergonomics is the study of the work environment and its effect on humans. Three types: 1. Physical: deals with the interaction between a person's body and machine. 2. Cognitive: Also known as engineering psychology, deals with interaction between the human mind and work. 3. Organized: Also known as macro ergonomics, deals with the culture of work including issues of safety and ethics. When implementing a new information system in a medial facility, it is important to consider all three types of ergonomics. First, the interactive devices (e.g. computer screens and keyboards) must be physically easy to work with and have a low risk of physical injury. Second, the staff must be psychologically willing to value the new computer system and use it effectively. Finally, the ethical use of the system must be defined and written standards put in place to assure consistency.

The training process for naive computer users

For employees that have little or no computer experience, remedial training is required. These individuals may feel intimidated by the idea of working with a compute3r system for the first time. It is important to address their fears and make them feel comfortable in the training environment. It may be useful to introduce them to basic computer use with a game (or other skill building software) before moving onto something more complex. These individuals may need to be taught basic computer skills (e.g., how to use a mouse and how to print documents).

Testing method: Functional testing

Functional testing verifies that a code is functioning properly and determines if users are able to carry out certain functions or whether features in the software work as expected. Functional testing may include manipulating data, conducting searches, using user commands, and accessing user screens. Integration testing is also conducted as part of functional testing. Functional testing should be computed on units during development and on the system as a whole after integration. Functional testing should also be conducted from the perspective of the end-user, so functional testing should always be designed to correspond to end-user requirements. Functional testing may include both manual and automated testing components. Functional tests should be able to identify system level faults and problems.

List common task associate with system maintenance

Include both hardware and software. Hardware activities revolve around the consumables and physical storage requirements associates with printing and backing up system data. Software activities are associates with the updates of system software and the related testing/change control procedures. Specific system maintenance tasks include: >> Troubleshooting hardware and software problems. >> Keeping and adequate supply of replacement hardware (e.g., printer, cables, and monitors) and consumables (e.g., toner and ink cartridges). >> Performing system back up procedures according to a predefined schedule. >> Making sure the system has enough storage capacity,. >> Applying system upgrades and software patches, >> Making sure disaster recovery plan is in place and ready for implementation.

Six elements of the system that are necessary for formation

Interdependency: there must be multiple components that interact with each other in a concert way Inputs: Data is placed into the system from an external source Process: the overall functionality that the system contributes its various components towards achieving. Output: The product of the system. The end result of the various interdependent components of the system. This is usually a distinct product that can only be achieved if the system is operating correctly. Control: Operation that works to prevent or correct problems as they occur throughout the process. This is usually intended to her feedback mechanism. Feedback: An internal control mechanism that allows for the detection and correction of processing problems. This can also include the monitoring of the external environment for an open system.

Discussed system planning concepts and considerations: Internal customer-supplier relationships

Internal customer-supplier relationships in an organization must be identified and understood. Internal customers are those directly involved in product or healthcare delivery, such as those on the Board of Directors, clinical staff, administrative personnel, nursing personnel, medical support staff, physicians, human resources personnel, plant managers, pharmacists, and volunteer staff. A customer is, by definition, a receiver. Internal customers need others in the work environment to provide some type of product or service so that they may function, and they, in turn, provide a product or service to others, so each internal customer is also a supplier. Vertical customers-supplier relationships, such as between administration and nursing staff, are sometimes more obvious than the equally important horizontal relationships, such as between four nurses, which can involve cooperative measures to ensure the quality care is provided. Identifying customer supply relationship should be part of a strategic planning and increasing internal awareness and improve methods of meeting the various customers needs.

Describe internet-based and on-the-job training approaches to information systems.

Internet-Based Training: delivers content directly to students via the internet. Advantages: Accessible from any PC that is connected to the network, available 24 hours a day. Disadvantages: Highly trained webmaster needed, Intranet must already be in place. Tips: Online learner assessment is included. On-the-Job Training: delivered to the student in-person usually at the work site itself. Advantages: Can be tailored to the individual, Learning is applied immediately, Proficiency is tested by the trainer. Disadvantages: Productivity is less during training time, Bad habits can easily be passed on, Interruptions are extremely bothersome Tips: Trainer should be knowledgeable in adult education, Works well for lower level staff.

Discuss teaching strategies and methodologies: one-on-one instruction

Is the most costly for an institution because it is time intensive. However, it allows for more interactions with the instructor and allows users to have more control over the process by asking questions or having the instructor repeat explanations or demonstration. One on one instruction is essentially valuable when users must master a particular skills or if confidentialities is important.

Describe the strategy of scheduling user-training sessions

It can be challenging to train the staff of an organization that runs 24 hours a day, 7 days a week (such as a hospital). Finding the best time to train staff members will depend on their overall availability. People may often have to come in late (and be too tried to concentrate) if they are scheduled for a training session after their shift ends. The best strategy may be to allow individuals an entire day for training purposes. It may also be necessary to offer training during all three shifts in order to accommodate shifts personnel. Trainees should be given material to review in advance of the training session so that they will be fully prepared. Training should also be timed to occur as close to the go-live date as possible so that the new information will be remembered.

Discuss developing teaching materials and resources: Selection.

It is impractical to believe that the nurse can produce all teaching materials and resources, but careful consideration must be given to the selection process. >> Price rages from free to hundreds or even thousands of dollars for educational materials, which may be handouts, videos, posters, or entire courses or series of course available online. The nurse must first consider the budget and then look for material within those monetary constraints. Government agencies, such as the Center for Disease Control, often have posters and handouts as well as slide show presentations and videos available for download online at no cost. >> Quality varies considerably as well. The nurse should consider the goal and objectives before choosing materials, and the materials should be evaluated to determine if they cover all needed information in a clear an engaging manner. >> Currency must be considered as well. If material will soon be outdated because of changes in regulations, then it will have to be replaced.

Testing method: Load, or volume testing

Load, or volume testing, is a type of nonfunctional reliability testing that evaluates the system's ability to function under different loads, such as during normal use times and peak times with multiple users to determine maximum capacity and problems that might be encountered. This test involves evaluation the effect of volume on the system to determine limits. Testing tries to determine at which exact point problems arise. this can include static and dynamic testing of the system at the safe work load (SWL) and above the SWL. Volume testing may include testing the ability of an application to handle a certain volume of data, such as in a database. Volume testing should always be concluded before a system becomes live to prevent crashes and loss of dat air limits are exceeded.

Analysis of system performance effectiveness through maintenance, recovery, and regression.

Maintenance- this testing is done to identify problems requiring maintenance with equipment or applications or to evaluate the effectiveness of repairs. Maintenance testing is often done on software already in use when it is changed in some way or installed in other hardware. Recovery- This involves purposely crashing the system and evaluating the system's ability to recover. Techniques include restarting the computer in the middle of an action, unplugging the device during data retrieval, and restarting the browser after accessing a number of different windows to determine if memory and access to the window remain intact after restarting. Regression- This tests the system after a change, such as installation of a patch or a change in configuration, to determine if the change has introduced faults into the system.

cost effective analysis (CEA)

Measures the effectiveness of an intervention rather than its monetary savings

Gap Analysis

Method used to determine the steps required to move from current state or actual performance to a new one of potential performance and the gap between the two that requires action or resources.

Implementation strategy: Pilot implementation

Often used in large organizations or those with multiple locations to "try out" the new system before it is implemented further. This is similar to phased implementation except that it is usually limited to one or a few units, an extensive evaluation is usually completed during the pilot program. This evaluation includes interviews with users to determine what faults exist and assessments of end-user acceptance so that any alternations or modifications can be completed before further implementation. With pilot implementation, initial training may be restricted to those in the pilot program. The early adopters may be used as trainers and mentors in later implementation. Pilot programs are often easiest to assess in stand-alone units that do not require a lot of data transmission to and from other units.

Programming algorithms: Serial

One instruction is performed after another.

Describe the advantage and disadvantage of the multimedia and tutorial methods of online training.

Online multimedia advantages: >> Interactive: The trainee can access live feedback >> Improves retention: Instructor may be asked questions. >> Test of proficiency can be used: Real-time evaluation may be conducted with the trainees. Online multimedia disadvantages: >> Instructor and trainees must be available at predefined times >> Technology related problems may cancel the session >> Trainees need access to a computer and network connection. Online tutorial advantages: >> The tutorial is available to the trainees 24 hours a day (7 days a week). >> The trainee can revisit the sections they are having trouble wit or need additional time. >> Off-line examinations can be administered Online tutorials disadvantages: >> The success of a tutorial is dependent on the richness and functionality of the design. >> The trainee may not be as focused on the materials as they would be in a live setting.

Explain the ways goals are set in an organization

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, measurable, and time based. The goal 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.

Discuss resistance to organizational change

Performance improvement processes cannot occur without organizational change, and resistance to change s common for many people, so coordinating collaborative processes require anticipating resistance and taking steps to achieve cooperation. Resistance often relates to concerns about job loss, increased responsibilities, and general denial or lack of understanding and frustration. Leaders can prepare others involved in the process of change by taking these steps: >> Be honest, informative, and tactful, giving people thorough information about anticipated changes and how the changes will affect them, including positives. >> Be patient in allowing people the time they need to contemplate changes and express anger or disagreement >> Be empathetic in listening carefully to the concern of others. >> Encourage participation, allowing staff to propose methods of implementing change, so they feel some sense of ownership. >> Establish a climate in which all staff members are encouraged to identify the need for change on and ongoing basis. >> Present further ideas for change to management

Implementation strategy: Phased implementation

Phased implementation of a new system may involve phasing by module, unit, or geography. In phased implementation, the system may go live in one or more units initially with units added on an extended phased schedule until all units have switched to the new system. This has the advantage of allowing for evaluation and revision on a smaller scale. Additionally, those initially using the new system may subsequently serve as trainers and resources for those who receive the system at a later time. In some cases of phased implementation, some aspects of a new system may be used throughout the organizations with other aspects added in phased steps. For example, all units may be able to retrieve data but only some to enter data. Carefully consideration should be given to which units should receive the new system first. It is usually best to begin with people with computer skills or those who support the new system. Disadvantages include disruption of operations, difficulty in accessing complete data, and staff confusion.

Steps in conducting a product analysis

Product analysis may be used to analyze one product or to compare a number of products. Product analysis may be conducted during the design of a product at any stage but may also be conducted to deterimine if existing products or prototypes meet desired criteria. Product analysis focuses on how products are made and used and their important features. Product analysis helps to identify flaws or problem areas in a product and can identify possible changes needed for improvement. Steps in product analysis include: >> Selecting product or products to be analyzed. >> Determining the target market or user >> Establishing a list of criteria: cost, usability, user learning curve, user satisfaction, integration, product construction and materials, quality, dimensions, safety, life cycle, and recyclability. >> Determining a scoring or ranking scale (e.g., 1 to 5, good to bad). >> Evaluating the products in terms of each criterion and assigning a score or rank. >> Assessing scores or ranks for problems or flaws. >> Identifying changes needed in product.

Project scope and project plan

Project scope defines the goals of an information system project, describing those elements to be automated and outlining both the context and the complexity. As part of the project scope, alternate solutions should be identified and feasibility considered. The project scope statement, which outlines the project plan, is usually done in the later stages of development as a guide for the user or consumer. The project plan should include the following: >> Objectives of the project and characteristics >> Requirements (in terms of services and products as well as deliverable). >> Acceptable criteria >> Limitations, boundaries, and constraints >> Assumptions >> Initial organization and preliminary timetable and schedule, taking into consideration the people assigned to different tasks and their skill levels. >> Identification of risks and methods to attenuate risks >> Initial work breakdown structure, dividing the project into organized sequential steps, such as with Ganttt chart >> Estimated costs and resources and creating a resource plan >> Management requirements >> Approval processes and requirements

List several ways to alleviate the detrimental effects of prolonged mouse use and prolonged sitting.

Prolonged mouse usage can lead to pain and nerve damage in the wrist, hands, and fingers. Solutions noon to help include: >> adhere to a break schedule, that allows you to stretch and rest your hands and arms >> alternated hand that uses the mouse. (For example, if you are left-handed switch the mouse to your right hand). >> perform a wider variety of work that involves more than sitting behind a desk. >> use an ergonomically designed alternative to a mouse, such as a track ball >> use keystrokes substitutions to avoid repetitive motions. Prolong, sitting complete strain on the back deck may lead to pain and nerve damage. The following is a list of solutions that are known to help: >> adhere to a schedule that allows you to stand up, walk and stretch. >> Use an adjustable chair to maintain a good posture. >>Place equipment (such as phone or printer) so that it forces you to get out of your chair. >> Consider a workstation that allows you to use the flexibility to sit or stand and perform your work.

The classification of programming algorithms: Divide and Conquer

Separates the problem into smaller and smaller sub-problems until each sub-problem can be solved easily.

Explain the procedure that should be followed when planning the go-live process

Set the date when the system is anticipated to go-live and whether the system will be scaled up in a staggered (according to a certain client types), modular (according to facility or department) or and all at once manner. Create an overall implementation strategy that includes: >> Transfer of data from the old system to the new system. >> Establish a user and system support system. >> Develop the various short- and long-term evaluation procedures to monitor the new system. >> Develop a change control procedure to assure that all changes to the new system are documented and carried out properly.

Disgust system planning concepts and considerations: staffing management

Staffing management involves both clinical staff (e.g., nurse) and non-clinical staff (e.g., housekeeping staff, office personnel). Important issues include the following: >> Workforce and distribution, including full-time equivalent staff members, needed. >> Educational resources, such as training programs, and availability of trained personnel, including professional staff and support staff. >> Staff training, ongoing needs for staff development, and opportunities for certifications or advancements. >> Demographics (i.g., age, economic levels, ethnic backgrounds, lifestyle). >> Incentives for career advancement, including increasing income, promotions, and certifications. >> Staff turnovers, burnout, and an ongoing need for recruitment. >> Organizational structure. >> Financial resources available. >> Cost-effective staffing and billable provisions of care. >> Reimbursement (i.g., Medicare, Medicaid, health insurance, private pay). >> Supervision/feedback. >> Organization-wide strategies for staffing

major steps used in strategic planning

Step 1: Develop a mission statement Step 2: Determine goals and objectives Step 3: Create a strategic plan to achieve the goals and objectives that includes: >> Identify potential solutions >> Select a course of action >> Implement the chosen solution >> Conduct regular evaluations including feedback from those involved in the strategic plan.

Efficiency studies

Studies that attempt to evaluate the effectiveness of therapy under actual conditions in real-world settings.

Compare super user and job-aid training

Super users: regular user of the system who has in-depth knowledge of the information system. Advantages: Understands the clinical areas and the information system; Any user may apply for this position. Disadvantages: Must take time away from clinical position; Must attend information system meetings Tips: Is a good assistant trainer; Can help other users on the job. Job aids: learning tools used at the workstation Advantages: Lessons the need to memorize large amounts of information; Lesson the amount of time needed for dedicated training. Disadvantages: Access must be complete; Aids must be up to date Tips: User friendliness is key; All users must be given same information.

Describe supportive, scooped key, minimum-motion, and straight column keyboards

Supportive keyboards: These keyboards have a built in wrist rest. While the wrist rest may help the individual user sit with a more comfortable posture, it may also allow fluid to build up in the carpal tunnel causing wrist pain. Scooped key arrangement keyboards: These keyboards are designed in bowl-shapes. This type of design has the keys set closer together which allows for an extra row of keys. The intent is to reduce reach fatigue. Minimum-motion keyboards: These keyboards were developed to change the way the individual keys are operated. Rather than pushing the keys down flat )as is the case with traditional keyboards), the user only has to lightly touch them. This is meant to reduce muscle tension and finger pain. Straight column keyboards: This keyboard places keys running straight up and down instead of in diagonally offset rows (as is the case for traditional keyboards). This arrangement helps to lessen stress on the left hand with little effect on the right hand.

System failure

System failure may result in the hardware freezing or software malfunctioning. In some cases, the system may reboot, but in other cases, it may simply stop functioning. Error messages may help to indicate the type of problem that is occurring and may guide troubleshooting efforts. Policies should be in place to guide procedures during the time the system is not available (e.g., downtime planning). Common causes of system failure include user\operator error, power disruptions/disconnections, overheating, and equipment malfunction or failure. Fast response to identify the cause of the system failure and repair to get the system up and running again are essential, but recovery, such as entering paper-stored data, much also be completed along with verification to ensure that data have not been corrupted and that the system is functioning properly.

How the system theory can be applied to the strategic planning process

System take information (called input), process it, and then produce new information (called output). Feedback controls the processes that occur within a system. The functional parts of a system and its processes are interdependent. A change or problem in one part of a system can affect the system's overall processes and this may cause problems for other parts of the system down the line. A secondary malfunction is defined as a change in one part of a system due to a problem in another part of the system. Problems must therefore be corrected at the area of the primary malfunction in order to prevent. a secondary malfunction. If a problem affects the system's function, it can also affect the output. To simplify, a system is more than the sum of its parts and is not equal to the function of its individual parts.

Developing screens for consistency and ease of use: Text

Text is more tiring for the eyes on the screen than on the printed page because of the illumination of the screen, and some fonts may blur in browsers, so fonts especially designed for the internet, such as Verdana and Lucida Sans/Grande, should be used for text the will be accessed by a browser. Using a variety o fonts and multiple sizes on one screen can be very distracting. Long paragraphs should be avoided, and information should be presented in small paragraphs with adequate white space to rest the eyes. Font size should be 12-14 for standards text with larger sizes for headings. Text against a colored background, especially a deep color, is difficult to read. When highlighting text, underlining is more evident than italicizing and bolding because screens have different lighting and resolution. Colored fonts may be used sparingly to highlight different types of information. For example, a question or heading may be in a blue font and an explanation in a black font.

American with Disabilities Act

The 1992 Americans with Disabilities Act (ADA) is civil rights legislation that provides the disabled, including those with mental impairment, access to employment and the community. The ADA prevents discrimination against employees or potential employees for organizations with fifteen or more employees or potential employees for organizations with fifteen or more employees because of disabilities. The Equal Employment Opportunity Commission enforces these provisions. Employers are only allow to ask applicants if they need accommodations, not if they have disabilities, and individual accommodations must be made. Accommodations can include the following: >> Alterations in work station >> Speech recognition software >> Screen magnifying software >> Optical character recognition systems >> Video captioning >> Braille readers and screen readers >> Adapted keyboards and on-screen keyboard >> Teletypewriter or text display device >> Amplification systems People who are disable are entitled to assistive technology that will allow them to function but are not entitled to jobs that they are unable to do even with assistive devices or accommodations. Most computer operating systems now incorporate assistive technology.

System enhancements

The availability of a system enhancements, such as software upgrades, new software, and new hardware, is almost constant, but constant changes to a system can result in changes in functionality and need for increased resources in training. A committee that reviews requests for enhancements can help to determine which are needed by the organization and which are unnecessary. Enhancements should be evaluated in terms of impact on efficiency and cost effectiveness. Introducing enhancements to a system that change functionality requires advance notice to staff and, sometimes, additional training, so holding the introduction of enhancements to a schedule, such as every six weeks, may be less destructive than routinely updating software and equipment as updates become available. Testing the enhancement should be completed, when possible, before wide dissemination.

Describe the advantage and disadvantages of e-mail and video methods of training

The following advantages and disadvantages of the e-mail and video methods of training include: E-mail advantages: >> Trainees receive training materials electronically >> E-mail messages are easy to assemble and send to targeted trainees. E-mail disadvantages: >> Trainees must open the mail and follow the instructions for completing. >> Responses might be slow or non-existent without stringent follow-up procedures. Video advantages: >> Videos are available 24 hours a day, 7 days a week. >> Exposes many trainees to a single point of training material. >> Easy to distribute and can be shared by trainees within uniform functional areas. Video disadvantages: >> Requires expensive cameras and production techniques >> The instructor must be familiar with presenting the training material through the video medium.

List some important factors of ergonomically designed computer workstations

The following are some important ergonomic factors in regards to the design of computer workstations: >> Deciding how it will be used: How will the user interface with the information system? >> Finding out how long the user will be in place: How many hours will the user be stationed at the interface? Is the time continuous? >> Configured based on the equipment to be used: Does the user have to turn or reach for various components of the information system during their routine operations? >> Located in areas of low noise: Is the noise environment conducive to the tasks the user needs to perform? >> Located in areas of good ventilation: Are environmental conditions appropriate for the user and equipment? >> Use stable workstation furniture: Is the workstation furniture suitable for the equipment that it supports? >> Educate users on proper usage: Do the users follow the proper ergonomic procedures for performing their job? >> Choose chairs with proper back support: Is the user's chair appropriate for the user in terms of adjustability and back support?

Discuss the characteristic that should be taken into account when choosing an information system trainer

The following characteristics should be taken into account when selecting a trainer for information systems: >> Experience: Has the trainer worked with hospital information system (HIS) previously? How knowledgeable are they regarding the newly installed system? >> Style: How does the trainer work in group situations? Are they good at the communication and coaching aspects of he training session? >> Organizational fit: Is the individual familiar with the training approach and philosophy that the organization prefers? >> Working with upper management: Will the individual be able to train users on the specialized departmental level?

Describe four factors to consider when choosing a training method for a new information system.

The following four factors should be considered when choosing a training method for a new information system: 1. Time: Different training methods take various amount of time to prepare and perform. 2. Cost: This include the cost of trainers, equipment, and the number of hours that employees will need to spend away from their job. 3. Learning styles: It is important to consider the predominant successful training style for the organization (what works best for the majority of trainees). This may be determined by the demographics (age, gender, education) of the trainee pool. 4. Learning retention: Retention of training concepts may be much higher if the training is "hands-on' (or in-person) rather than self-taught.

List the factors to consider when choosing a training site.

The following is a list of factors to consider when choosing a site for information system training: >> Is there space available to conduct the training on-site or will an off-site facility be needed? >> Is the training budget adequate to allow for the option of off -site training? >> Are their enough computer terminals for all of the trainees or will they have to share a terminal? >> Is the site properly configured with power outlets and network connections? >> If the training is at an off-site location, is it convenient to the trainees in terms of parking and proximity to work? >> Is the site prepared with all of the required training materials?

Steps of the system implementation plan

The following steps are involved in administering the system implementation process: Step 1: Develop a schedule (with strategic milestones) that will be used to install the new system. This is sometimes referred to as the work breakdown structure (WBS) of the project. Step 2: Assign tasks. These tasks should be specific, assigned to capable persons, and tracked (for completion). Step 3: Establish communications plan that covers the methods and timing of all communication within and outside of the implementaiton team. Step 4: Test the system (in a controlled test environment) before going live. This gives the users and a support staff opportunity to stress the system and assure that it is operation properly.

How informatics nurses can utilize the help-desk ticket system to support end-users.

The informatics nurse should routinely assess help-desk tickets to determine the types of problems that end-users are encountering. Whether the organization utilizes an automated cloud-based hosted service or an in-house service, the help desk should maintain records of all calls or requests, so the informatics nurse can review the tickets and assess whether problems are scattered or if a pattern, such as increased types of one request or increased request from one unit, emerges. Having a standardized help-desk request form, m which can be filled in online, is especially useful to track issues. Any time there is an increase in requests, the informatics nurse should evaluate the types of requests (looking for patterns),m interview the help-desk staff for their input, and interview and observe end-users. Based on these assessments and observations, the informatics nurse may recommend changes in hardware, software programming, or additional training for end-users.

Methods used to analyze end-user acceptance of systems

The primary purpose of most end-user testing is to identify errors. Testing may be done to verify that the system functions as intended or to validate that the system functions in a way that meets the requirement of the organization. A number of different methods can be used to analyze end-user acceptance of systems. >> User acceptance testing with scenarios in which users carry out representative tasks >> interviews with users regarding usability and other problems. >> Questionnaires for users to determine perceptions of usability. >> Comparative studies with users using different systems of methods. >> Direct observation of users carrying out tasks >> indirect observation of users carrying out tasks, such as by video. >> Analysis of computer-generated data to determine accuracy and number of errors.

Enterprise-wide strategic planning

The process requires that an organization look at needs of the organization, community, and customers and establish both short term (2-4 yrs) and long-term (10-15 yrs) goals. Strategic planning must be based on internal and external assessments to determine the present course of action, needed changes, priorities, and methodologies to effect change. The focus of strategic planning must be on the development of services based on identified customer needs and then the market of those services. Enterprise-wide strategic planning includes: >> Collecting data and doing an external analysis of customer needs. >> Analyzing internal services and functions >> Identifying and understanding key issues, including the strengths and weaknesses of the organization, potential opportunities, and negative impacts. >> Developing revised mission and vision statements that identify core values >> Establishing specific goals and objectives.

Incremental Cost Effectiveness Ratio (ICER)

The ratio of cost change to outcome change

Role of system support

The role of system support encompasses all of the activities required to make sure the system is operating as it was designed to perform. Performance issues (e.g., a slow system response time) may indicate that the system is about to crash. Detection of problems is as important as troubleshooting items the that have already broken. Specific system support activities include: >> Fielding all request made during the implementation period >> Establish ongoing communication between the system administrators and the system users. This may take the form of a printed newsletter, e-mail updates, or an in-house focus group. >> Establishing a 24-hour telephone help desk. >> Performing follow-up to all completed help requests to verify that the problem was adequately resolved.

Describe the findings of current ergonomics research

The user of the ergonomic device has to be evaluated along with the equipment and setting. All humans are different and have different ergonomic needs. The best ergonomic solution for one individual may not necessarily work for another. It should also be noted that the workstation may not appear to be configured in the best way to the supervisor (or casual observer), but may indeed be the best for the user. There is no such thing as a true ergonomic chair. Chairs are manufactured with many adjustable features. Some of these are effective and some are not. Chairs should be chosen that would accommodate the widest variety of users (body types) that will be sitting on them. Additionally, chair parts and padding wear out very quickly. What may have once begun as a very suitable ergonomic chair could deteriorate into a poor choice in a relatively short amount of time. Used chairs should be refurbished or disposed.

Discuss developing teaching material and resources: Electronic and audiovisual materials

There are a number of issues that must be considered when teaching a course and determining the appropriate audiovisual and handout materials. The physical environment is a major consideration, especially when using electronic and audiovisual materials. First, everyone in the room must be able to hear and see. In a small room, a television or computer screen may. suffice, but in a large space, a projection screen must be used. Another issue is lighting. Some projectors have low resolution and the lights need to be turned off, dimmed, or windows covered. Turning lights on and off a dozen times during a presentation can be very distracting., A small portable light at a speaker podium or an alternative presentation can be used. Text size for presentation is another issue: Slide shows or other presentations that include text must be of a sufficient font size to be read from the back on the room.

Describe peer training and self-directed text-based courses used for information system training.

There are two basic methods for carrying out information system training: 1. Peer Training: This is a method in which new users of the system are trained by existing users (their peers). The new employee shows the peer and is coached on the proper operation of the system. Advantages: Training is tailored directly to the function needed Proficiency can be easily tested. Disadvantages: Trainer may not knowledgeable in principles of educating; Existing bad habits can be easily passed on. Tips: Trainer should be knowledgeable in adult education; Works well for lower level staff. 2. Self-Directed text-Based Courses: This method is based on self-directed (and self-paced) trading by use of the provided materials. The materials are usually in the form of workbooks that can be studied at home or during breaks on the job. There is very little interaction with the subject matter experts. Advantages: Individual works at their own pace Proficiency is easily tested; Hospital system doe snot need to be in place for training to go on Disadvantages- Personal motivation has to be hight Tips- Material must be highly structured.

Discussed teaching strategies and methodology: Just-in-Time Presentations

These are used when learners need to use the information immediately. For example, if teaching learners to access data and a new computerized system, a supportive overview of the system and its purpose may be given right before hand-on practice and basic instructions about use. However, only when the user needs to access data is the presentation about access provided. This allows learners to draw on what they have learned immediately without the typical memory loss that occurs when people try to retrieve information they learned at an earlier time. Just-in-time presentations are especially useful with procedural instructions that is not very complex and that helps people master a specific task. A training session may include both supportive information given immediately before practice and in just-in-time presentation interspersed throughout the session.

carpal tunnel syndrome

This is the most well-known repetitive stress injury. It involves the compression of the median nerve located in the wrist. It is usually seen in individuals who spend many hours in front of a computer screen typing. Economic keyboards and wrist rests have not been shown to significantly decrease the chance of developing carpal tunnel syndrome. Many sufferers do report relief when using wrist splints at night to rest their affected hand(s). One of the best ways to keep from developing carpal tunnel syndrome is to the frequent breaks from the keyboard or mouse and perform simple exercises designed to alleviate pressure on the median nerve. Once carpal tunnel syndrome has been diagnosed, it can be treated with steroid injections, anti-inflammatory medications, or (less commonly) surgery.

Analysis of system performance effectiveness: scalability

This tests the ability of the system to function under increasing loads. (scaling up) or under increasing notes (scaling out), such as adding computers or servers to the system. Scaling may be strong or weak.

The components of the system selection process

Three components: 1. Needs Assessment: This first action takes place after the decision has been made to purchase a new system or upgrade an existing system. Information is gathered regarding the current state of the art and how the offerings in the marketplace meet the criteria defined needs of the organization, as well as the future needs. Typically, the selection committee attends trade shows and sales meetings that are set up by the potential vendors of the systems. 2. Request for proposal (RFP): Once the pool of potential vendors has been narrow down. (typically to three), RFPs or sent out. The resulting proposals are then evaluated, references are checked, and the system is evaluated in action (wherever possible). 3. Contract negotiation: the winning system is then selected and a contract is negotiated with the vendor. Once the contract is approved, implementation plans may proceed.

Describe the different types of ergonomically. designed keyboards

Three major types of ergonomically designed keyboards: 1. Split keyboard: This type of keyboard was designed to minimize the occurrence of the hand and wrist position the places pressure on the major nerves in the wrist. There are two types of split keyboard designs; one directs each keyboard half out toward the elbows while the other completely separates the keyboard so that the halves can be located in-line with the elbows. 2. Tented keyboards are similarly split into two halves; however, they also allow the typist to angle their palms toward one another reducing the joint posture known as pronation. 3. Negative-slope keyboards were developed to reduce wrist extension by allowing the user to tilt the keyboard to a flat or backward slope opposite of the more traditional positive slope keyboard. Ergonomic research results for these keyboards are mixed, with individuals who already have ulcer nerve damage receiving the most benefits.

Describe the areas of training for information systems

Training employees on a new computer system should take the user through each part of the system that they will be working with. They should be introduced to the exact steps needed to perform each function. that is required by their job. Simulations of potential challenging situations should be practiced. Additional features such as basic troubleshooting help screens and online tutorials should also be introduced to the trainees. Specific areas for training staff on information system include: >> The basics of how the computer system works, This includes both the hardware and software. >> How the system impacts their areas of responsibility. This should include some "hands on" training at the individuals' workstation. >> The computer support resources should be painstakingly outlined so that the staff member knows exactly what is available to them and at what times.

Programming algorithms: Iterative

Uses constructs that repeat themselves many times with the possible addition of other information to find a solution.

Programming algorithms: Deterministic/Non-Deterministic

Uses precise decisions or uses a heuristically designed system of guessing

Discuss developing teaching material and resources: Video, videoconferencing, and teleconferencing

Videos are useful adjunct to teaching as they reduce the time needed for one-on-one instruction (increasing cost-effectiveness). Good-quality videos can be expensive to produce, although commercial products are available. Passive presentation of videos, m such as in a waiting area, has limited value, but focused viewing in which the educator discusses the purpose of the video presentation before viewing and then is avail for discussion after viewing can be very effective. Videos are also effective tools for demonstrating patient care techniques, such as wound care. Additionally, videos can be placed on course or learning management systems for anytime assess. Providing focused questions for use during the video presentation helps increase retention by keeping active involvement. Videoconferencing and teleconferencing allow for audiovisual collaboration at a distance and can be a valuable tool for education, providing access to experts without the transportation costs. In teleconferencing, students may be at multiple sites while interacting with each other and an instructor.

Discussed reporting an analysis to the stakeholders

When reporting an analysis to the stakeholders, the first step is to determine the factors that are most important to the specific stakeholders. Well analysis may have involved many steps, it's a report is most concerned with the end result of the analysis. Data should be presented in a visual medium, such as in charts or diagrams.

Discuss the following collaborative tools: WebEx

a Cisco company, provides applications that allow for internet-based videoconferencing and collaboration. WebEx products include the Cisco WebEx Meeting Center, Training Center, Support Center, and Event Center. WebEx provides a number of services, depending on the product used, including the following: >> Face-to-face internet meetings in real times >> Notifications >> Training for users: interactive internet training with video and a variety of interactive tools to allow learners to participate actively in learning, including chat rooms and question and answer threads. >> Live-streaming >> Consultation >> Business management >> Instant messaging >>E-mail management WebEx allow participants in internet conferencing to share content, such as images and videos, in real time; thus, it allows people to collaborate at any time and from any distance, reducing the need to travel and allowing immediate consultation and videoconferencing, such as during surgery. WebEx is used for both business and education, especially for delivery of online course or supplementary material for more traditional classes.

Discuss the following collaborate tool: SharePoint

a Microsoft product, is a Web-applicaiton platform that is integrated with Microsoft Office tools and can be used for content and document management, collaboration, social media, and development of websites and Intranets. SharePoint provides centralized storage of documents, which can be accessed through password-protecgted portals. SharePoint sites can store list and libraries. The SharePoint "wheel," or outcomes that SharePoint can facilitate include the following: -Creation of sites or work environments - Establishment of communities, such as for sharing information or collaborating - Management of documents, including storing, tracking, updating, allowing collaboration, and archiving. - Inclusion of search functions, based on keywords as well as analysis of content - Provision of information and insights to promote effective workflow - Allowance of composites and data integration -Templates are available for the creation of sites and subsets, and navigation is similar to that of Office products.

Discuss teaching strategies and methodologies: Over-the-shoulder instruction

a learner-centered strategy in which the instructor moves about the classroom monitoring the learners progress rather than standing at the front of the classroom and lecturing or providing instructor focused teaching. Most instruction is computerized learning, so students attention is often focused on technology. Advantages are that this strategy allows for one-on-one instruction with individuals learners as the instructor observers a need or the learner request assistance, and the instructor is better able to monitor individual progress. However, disadvantages are that the many learners may have the same question so the instructor may waste time answering the same question multiple times to individual students. Additionally, if the group of learners is large, instructor may not be able to address the needs or questions of all students. In some cases, the learning environment may seem impersonal because of less interaction with the instructor.

Discuss developing teaching material and resources: Written handouts or paper materials

are a fixture in classes, but many end up in the wastebasket without ever being used; thus, thought should be given to what useful information should be in the handouts: >> Handouts that simply copy a slide show presentation or repeat everything in the presentation are less helpful than those that summarize the main points >> Giving out handouts immediately before a discussion ensures that most of the class will Abe looking at the handout instead of the speaker. Thus, handouts should be placed in a folder or binder and passed out before the class meets so students can peruse them in advance; for example, handouts can be passed out at the end end of the class in preparation for the next class. >> Handouts can be used to provide guidance or worksheets for small-group discussions. >> Posters that can be placed on bulletin boards are useful. >> Handouts should be easily readable and not smudge copies of newspaper articles or small print text.

Discuss developing teaching material and resources: Hospital information system

can provide real practice for students and trainees using hardware and software programs that they will need when caring for patients. Nursing students can use HIS to generate care plans and do mapping rather than doing in the traditional time-consuming paper method. The students and trainees should be able to access fictitious patient files and retrieve and enter information, but security must be in place to prevent access to actual patient files for training purposes as this violates the Health Insurance Portability and Accountability Act (HIPAA) regulations. Additionally, existing staff, such as nurse managers, should be taught how to access data from patient census records and electronic health records (EHRs) to plan staffing, organize care, and promote patient safety. Any training involving HIS and EHR must review HIPAA regulations as well as methods to ensure data security and patient confidentiality.

Discuss system planning concepts and considerations: External customer-supplier relationships

critical to an organization because these customers receive product or services supplied by the organization. External customers include patients and their families, private physicians, vendors, insurance companies, government regulatory agencies, lawyers, and other in the community. As with internal customers, each external customer is both a receiver of products or goods and a supplier. For example, a regulatory agency provides regulations and guidelines as a supplier and then receives reports in return as a customer. This symbiotic relationship must be clearly understood because the external customer-supplier relationship is one over witch the organization often has less direct control, so identification of the customers' needs through surveys, interviews, focus groups, research, and brainstorming can help to clarify and improve these relationships.

Discuss system planning concepts and considerations: Inventory

describe the amount of material or equipment on hand, which should be reviewed at least once a year. In many cases, re-ordering is done when the amount of a particular item drops to a certain pre-established level. Just-in-time ordering is done when stocks is almost depleted. Automatic re-ordering of supplies is easy when inventories are computerized. In some cases, departments have open accounts that can be used for small purchases without bidding. For large purchases (especially in public institutions), the nurse should state exactly (i.e., include brand names when appropriate) which items are to be purchased on a bid form. The beds are them sent to perspective bitters (at least three) in a competitive bid process. Organizations vary in what bids are acceptable. Some only accept the lowest bid, while others accept the biggest bid (e.g., those supplying brand names rather than substituting with generics). Many organizations have private purchase plans that allow them to purchase directly without bids or lease equipment, which is less expensive initially.

Discuss teaching strategies and methodologies: Problem-based learning

developed by McMaster University in the 1960s. its is learner-centered with the instructor serving as facilitator rather than lecturer. The learners are presented with a problem and must search for the solution. Problem-based learning focuses on promoting the learners' ability to use critical thinking and problem-solving skills, increasing motivations. This process of problem-solving is believed to enhance transfer so that information learned in one context is internalized and can be used in other contexts as well. While effective, this method requires more preparation time ad may require an extended learning period while the learner identify the problem and attempts to formulate a solution. The teacher/facilitator can guide the learners by helping them to ask questions that lead to solutions.

open systems

do not have fixed or permanent boundaries but are instead of constantly being re-defined as they interact with the environment. An open system may be a sub system and can overlap other systems. In computing, an open source program allows access to the source code. This allows customizations and updates from the users and programmers in an open environment.

Discuss teaching strategies and methodologies: Blend/hybrid learning

encompasses a wide range of teaching methodologies. Blended/hybrid learning combines traditional lecture-type, instructor-focused delivery with more modern approaches, such as computer-based instructions. With blended-hybrid learning, the instructor often balances classroom learning with out-of-classroom learning, using various technologies, such as smart phones, iPods, and iPads to access internet-based, computerized modules or applications. When designing a blended-hybrid course, the instructor must consider the expected outcomes and competencies the learner must master, the size and nature of the audience, the location of learners or classrooms, and the available resources. A typical blended/hybrid class begins with an introduction by the instructor and then moves to other formats, such as computer-based learning, while the instructor assumes the role of facilitator, using jus -in-time presentations and combining over-the-shoulder, one-on-one, and group instruction as necessary to meet the class goals.

Discuss system planning concepts and considerations: payback period (PBP)

for an investment refers to the amount of time required for the savings resulting from the investment to equal the cost of the investment. To calculate payback period, divide the cost of the investment by the savings it provides. The payback period is essentially the inverse of the ROI.

Collaborative tool: Social Media

internet-baed programs/technology that allow users to interact with other online. Social media sites, such as Twitter, Facebook, YouTube, and LinkedIn, allow user-generated content (UGC), such as blogs, images, videos, and audio files, which are accessible by the public; however, many social media sites, such as FaceBook, allow users to control access through privacy settings. PatientsLikeMe.com is a health-related website with interactivity. Internet tools used for health-related social media sites are often referred to as Health 2..0 or Medicine 2.0 and can include blogs, wikis, search functions, video casts, and podcasts. Internet tools are increasingly used for medical education, especially in nursing curricula. Facebook is increasingly used for promotion and education by medical practitioners and other health care providers. For example, Healthcare.gov provides links to other government organizations and articles and allows users to subscribe and comment.

Discuss teaching strategies and methodologies: Group Instruction

is less costly because the needs of a number of people can be met at one time. Group presentations are more planned and usually scheduled for a particular time period, so learners have a less control. Questioning is usually limited and usually only at the end of a session. Group instructions allow learners with similar needs to interact. Group instruction is especially useful for general types of instruction, such as managing diet or other lifestyle issues.

Describe the advantages and disadvantages of instructor led classes for training

is one of the most popular type of training for information systems. Advantages: >> Uniformity: all trainees are exposed to the same material at the same time. >> Coaching: Trainer is able to interact one on one with trainees. >> Question and answer period: Trainees can have their questions answered immediately. >> Demonstrations: The instructor can demonstrate the use of the test information system (set up the class). >> Tests of proficiency can be used Disadvantage: >> The effectiveness of the training depends on the quality and knowledge base of the trainer. >> Larger class sizes can make training experience less effective. >> The trainer must keep the level of training in line with the average trainee's experience.

Implementation Strategy: Big-bang implementation

occurs when a complete system goes live across an organization on a designated data and time. For example, if the prior system involved paper documentation, this stops, and all entries are done on the new computerized system. The big-bang approach is best in small organizations where people have been well trained in the new system, have competent computer skills, or have mentors readily available. A phased approach may be better for large organization because inevitable problems arise during transition. Lists of those who are trained and can assist others should be published, and training should be a staffing consideration so that all units have mentors available. All data must be converted from the old system into the new system because implementation, and the validity of the data must be verified because errors can occur during conversion. Advantages are rapid change, less updating of documentation, and focused training. Disadvantages included confusion, lost data, learning curve, and startup problems. Fallback plans should be in place in the event of system failure.

Testing methods: System Integration Testing (SIT)

part of software/hardware testing, determines if hardware or software applications can work together. Integration testing is done after unit testing and before system and acceptance testing and involves testing how all the units function together. This is a type of blackbox testing that should not require knowledge of code, or inner product design. Purpose of the testing is to Jennifer problems or faults within the component parts (assemblages) or within the entire information system that affects performance. SIT may include load, volume, and usability testing. SIT involves development of an integration test plan that outlines what will be tested and how the test will be tested and how the test will be conducted as well as pass/fail criteria. Test cases may be developed to identify transitions and present and user scenarios. Test data should be developed to use in the test cases. Approaches to an integration testing include big bang (includes all components), top down (higher level components before lower level), and bottom up (lower level components before hight level).

Return on Investment (ROI)

refers to an accounting calculation that is used to determine the value that an investment provides.

Discuss system planning concepts and considerations: Return on investment (ROI)

refers to an accounting calculation that is used to determine value that an investment provides. Consider the following example ROI calculation the buying a new $20,000 piece of equipment for an employee. In addition to the cost of the investment, three other qualities must be known: 1. The annual cost of the employee who will use the equipment, 2. The percentage of work time that the employee will use the equipment. 3. The estimated (or calculated, if the analysis is done after the purchase) percentage increase in efficiency over the prior system.

Process interoperability

refers to processes and specification that facilitate exchange of data form one organization to another.

Discuss system planning concepts and considerations: resources use

refers to the consideration of all factors related to the planning and delivery of quality products and activities. Resources may be allotted to the physical environment for building or remodeling, staffing, equipment, literature, training, and outreach programs. Use review requires consideration of individual safety, program effectiveness, and cost. Intervention should be safe, effective, and affordable for each individual. Decision should take into consideration rising healthcare cost and how to maximize the use of resources while continuing to provide quality professional development activities. The goal of resource use is provide quality, cost-effective programs while using the best qualified staff and appropriate resources.

syntactical interoperability

refers to the transfer of data formats without necessarily ensuring that meaning is intact.

Sematic interoperability

refers to the transfer of meaning so that people recognize that the content transferred is the same.

Closed system

self-contained and isolated from the environment. The boundaries of a closed system are distinct and fixed. With the exception of an external energy source, closed systems do receive input from the environment and all output is contained within the system. A saline IV pump is an example of a closed system. In computing, when the source code is locked (by the vendor) the program acts as a closed system. All adaptation must originate from the vendor.

User-modeling studies: Conducting usability studies

steps include: 1. Defining Purpose: The purpose, which guides the choice of usability tests, should be clearly defined. 2. Evaluating constraints- the constraints may influence the type of testing and the design of the test. 3. refining components based on evaluation of human-computer interaction (HCI) framework- The HCI framework must be evaluated to determine each component and to whom or what it applies. This includes choosing the most appropriate staff, determining the most important step in a process, and choosing the setting. If testing involves comparison with older or more traditional practices, then measures of equivalency must be determined. 4. Determining emphasis- Usability testing may focus on one or more aspects, depending on the overall purpose. 5. Select methods- Methods must match purpose and take into account constraints and HCI evaluation.

Technical interoperability

the ability of two systems or equipment from different manufactures to exchange data. This usually refers to hardware/software or equipment that allows machine-to-machine communication.

Hardware Infrastructure Analysis

the process of reviewing the requirements that should be evaluated and satisfied before the new system is installed: -Network infrastructure: cable/wireless local area network (LAN) installations, available access points, and overall compatibility with the new system. -The type(s) of user workstation interfaces (desktop computers, laptop computers, terminals, etc.). -The location of the workstations (portable or permanent). -The physical location of the hardware (servers). -The connectivity and location of printers and/or other output devices.

process diagram: Gantt chart

used for developing improvement projects to manage schedules and estimate time needed to complete tasks. It is a bar chart with horizontal time scale that presents a visual representation of the beginning and end points of time when different steps in a process should be completed. Gantt charts are a component of project management software programs. The Gantt chart is usually created after initial brainstorming and creation of a time line and action plans. Steps to create a Gantt chart include the following: 1. List the name of the process at the top, 2. Create a chart with a timeline of days, weeks, or months (as appropriate for process) horizontally across the top. 3. List tasks vertically on the left on the chart. Draw horizontal lines or bars from the expected beginning point to the expected end point for each task. These may be color-coded to indicate which individual or team is responsible for completing the task.

Making recommendations for programming changes

- commonly occur with updates, upgrades, and addition of new features -careful evaluation of the value of the upgrade, needs of the organization, and associated time and cost in implementation when making recommendations -Changes in regulatory requirement may occur every year or 2, so monitoring requirements and making necessary programming changes are essential.

End-user acceptance or user-acceptance testing

- completed to determine end-users willingness to use computer technology or software in the way in which it is designed. -critical to successful implementation -Analysis of end-user acceptance should begin during alpa (completed by developer) or beta (completed by end-users) testing before complete implementation of a system. -Steps to analyzing end-user acceptance: 1. Analyzing the basic requirements of the system and the organization 2. Identifying the end-user acceptance scenarios 3. Describing a testing plan, including different severity levels based on real-world conditions 4. Designing the test plan and test cases, considering the risks and the skills of the end-users. 5. Conducting the tests. 6. Evaluating and recording results.

Analysis of system performance effectiveness: graphical user interface (GUI)

-allows user to interact with devices for the use of images, such as icons, rather than text, must be tested to insure it needs specifications. This is done by developing test cases that use all the functions. -have a large number of operations, so size and sequencing of actions are important considerations. -Open sources and commercial testing applications are available.

Analysis of systems testing for performance effectiveness

-completed after integration testing and involves testing the system as a whole to determine if it meets requirements, functional as needed, and meets expected outcomes.

Discuss validating data integration across disparate systems

-essential bc incorrect data can lead to serious problems with the system and provide false information. -Validating every item of data is virtually impossible, but doing spot checks of representative data may miss faults. -Validation should include assessing the size of data, including the number of files or records, before and after data transfer to disparate system to ensure it is the same data source is completely transferred correctly. -Data should be complete, accurate, and formatted correctly, and duplicate elements should be eliminated. Important elements of validation include: >> Validating across all levels of data, determining frequency, duration, and area of applications. >> Validating at high granularity (degree of breakdown into smaller units/parts) rather than low >> Automating validation >> Thoroughly understanding the source of data as well as its input and storage >> Customizing validation approaches, according to the needs of the organization.

Efficacy studies (RCTs)

-may compare a series of cost-benefit analyses to determine the intervention with the best cost-benefit. They may also be used for process or product evaluation.

Explain the role of the informatics nurse (business integrator) in the implementation of information systems

-support the process -Items to include in the implementation plan: >> a statement of support from the upper management of the company >> an assessment on how the new system will impact the various jobs that will be within the scope of implementation >> a complete overview of the implementation plan and the methods being used >> and assessment on how the new system will affect the company's culture (partially nursing) >> a budget that includes where the money will come from and how this will affect finances

The classification of programming algorithms: Dynamic Programming

Breaks the problem down into problems that have already been solved in order to find the answer more quickly.

Programming algorithms: Exact/Approximate

Determines a concrete answer or determines an answer that is close enough.

The classification of programming algorithms: Greedy Method

Makes sure of approximate answers to sub-problems and can be the fastest way to find solutions.

cost effective analysis

-measures the effectiveness of an intervention in terms of the monetary savings.

system test plan

-process of thoroughly testing to assure that the system is operating properly. -consist of four steps: Step 1: Develop the overall test plan. This includes the installation, operation, and validation of the new system. Step 2: Create the test scripts. These are the scripts that actual users of the system will use to "stress" the system to determine if it is working according to specifications. They should reflect real use as closely as possible. Step 3: Carry out the testing Step 4: troubleshoot and system's failing as soon as possible.

Cost Utility Analysis (CUA)

A subset of Cost Effective Analysis (CEA) which targets a special type of clinical outcome measure, usually the quality-adjusted life year (QALY)

The classification of programming algorithms: Search and Enumeration

Specifies rules in the form of a graph

Analysis of system performance effectiveness: security

- the testing is done to determine if data security is adequate in protecting confidentiality. It also tests authentication, access controls, availability of information, and nonrepudiation (enduring a record remains of messages sent and received). Steps include discovery, scaling for vulnerability, assessing vulnerability, assessing security, conducting penetration test to simulate an attack on the system, auditing, and reviewing.

Analysis of system performance effectiveness: software performance

- these tests are used to determine the ability of the system to perform under specific workloads. Software performance testing may include load testing, stress testing to determine upper limits, endurance testing to determine the length of time a system can function under in anticipated load, spike testing to determine if the system can function with the sudden dramatic increase in load, and configuration testing to determine if the system functions with changes in configurations, and isolation testing to repeat tests that resulted in failure or system problems.

Analysis of system performance effectiveness: smoke/power on

- this involves attaching an electronic device to power and operating the results ("smoke"). This identifies overload or overheating. And computer applications, this results in initial testing to a Denna five failures ("smoke"). Smoke tests maybe functional (testing the entire program) or unit (testing specific functions).

Analysis of system performance effectiveness: compatibility

- this may include certification testing to determine if the application functions properly in a targeted operating system or database. -testing, focusing on user experience, can encompass a wide range of tests, such as testing the system in different web browsers, evaluating the bandwidth handling capacity, determining if peripherals function properly , evaluating function of tools, and testing access to databases.

Analysis of system performance effectiveness: usability

- this test the ability of end users to use the system and application adequately. This may involve observation and "think aloud" to evaluate performance, accuracy, ability to recall steps, duration of time spent on a task, and personal response.

Analysis of system performance effectiveness: exception handling testing

- this type of error testing is done to determine if there are errors resulting from incorrect programming, coding, or resource failures, how the system response, and whether errors result in negative effects, such as corrupted data. - may involve hardware and software

Analysis of system performance effectiveness: ad hoc

- this type of exploratory testing is usually done once, and the user attempts to identify problems in an unstructured way by trying various means to elicit errors. - essentially a form of error guessing in which the user bases testing on previous experience with software.

programming language: structured query language (SQL)

-4th generation programing language (4GL) -uses syntax similar to human language to access manipulate, and retrieve data from relational database management systems, which store data in tables. -complex language Language elements: >> Clauses: from, where, group by, having, and order by >>Expressions: produce scales and tables >>Predicates: three-valued logic (null, true, false) and Boolean truth values >>Queries: require SELECT statements >>Statements: include the semicolon (to terminate a statement)

User-modeling studies: Cognitive walkthrough and ease of learning

-Cognitive walkthrough is one method to determine ease of learning of new technology or application. -Cog. walkthrough- method used to assess the user's ability to understand the model and its purpose, to produce the desired action, and to determine if user understand which is the right action and system feedback. -The "think aloud" procedure is used while participants use a product and carry out the steps in a process, noting any usability problems, such as the ability to learn the process without formal training. -Cog. walkthrough- particularly useful with prototypes or early in a system to a identify problems with design or usability

Archiving legacy data

-Cost-effective solution to archiving legacy data to archive applications -offloads data from the main storage system to an accessible format. -When determining which data are to remain active and which are to be decommissioned, the process includes: >> evaluating it auditing the data to illuminate redundancy >> determine what data or important for business/ legal reasons >> evaluating data to determine what should be active and in active >> evaluating legal requirements in relationship to data >> reviewing the organizational policies regarding data retention >> developing a plan for archiving and decommissioning data >> validating the integrity of the data

System elements to be tested: Screens

-Early computer screens used cathode ray technology (CRT), but this has been almost completely replaced by liquid crystal display (LCD) technology, used for flat panel displays. -LCDs have a lower power demand than CRTs or plasma displays; additionally, they are more lightweight and smaller. LCDs have two sheets of polarizing material with liquid crystal solution between the sheets. -For touch screen capabilities or use of stylus, an electromagnetic field is added. Consideration include: Refresh rate: This is the speed at which the screen reprints from top to bottom. Slow refresh rates on CRTs can cause flickering , but this does not occur with LCDs, which have a frame rate expressed in frames per second, usually about 60. Resolution: This is the number of horizontal pixels by vertical, such as 1440x900. The higher the resolution, the clearer the image.

System elements to be tested: Interface

-Interface engine software: where information is transfered from one system to a number of different systems. Translation tables move data from the clinical data repository to each system. Because terms may vary from one system to another, mapping is required to associate terms in one system with comparable terms in other systems. The serial peripheral interface bus (SPI) is a de facto industry standard, although different vendors have different configurations. SPI allows master/slave communication from the master device to single or multiple slave devices. SPI is full duplex and facilitates communication in both directions simultaneously. Half duplex interfaces facilitate communication in both directions but only in one direction at a time. SPI is used to communicate with variety of peripheral devices, such as sensors, clocks, liquid - crystal displays, universal serial bus ports, and communication.

data dictionary

-One of two major items of importance to integrate computer systems. Need to be recognized by the various systems that make up the integrated system, meaning data have similarities in structure and characters -A lists comply used terms, their definition, and their synonyms. It should also list the term that should be used by all departments as the de facto standard in order to facilitate integration.

master patient index (MPI)

-One of two major items of importance to integrate computer systems. Need to be recognized by the various systems that make up the integrated system, meaning data have similarities in structure and characters -lists all patients and their demographic information. It is important that teach individual be listed with several different pieces of data including: first and last name, social security number, and date of birth. The MPI should be set up so the new fields of information can be added easily and it can be scaled up as the business grows.

Interoperability

-The ability for two systems to exchange and use data while maintaining the same meaning, and this is an important element in the conversion of data. There are several types. Non-interoperability may result form lack of adequate system review, change in standards that interfere with the application to another system, and varying levels of technical quality form one system to another.

Testing methods: Automated testing

-Using software tools specially designed to test features of an information system, such as the graphical user interface (GUI). -does not require manual intervention. -The software may include tools to provide comparison data regarding expected and actual outcomes and well as other reports. Automated testing often mimics the action of user, but automated testing must include adequate testing scripts to be used effectively. Applications may include program monitors, debugging tools, GUI testing tools, profiling tools, and benchmarks. Metrics must be developed to address performance issues, and goals and expected outcomes of automated testing should be clearly defined. Automated testing is especially valuable in the types of testing that may not be practical to do manually, such as stress testing in which a system is testing with large numbers of simulated users.

System elements to be tested: Links

-allow access of information at one point from a different point. -Can be internal (within a document or screen). - can be external (website) >When the user clicks on a link, a transmission control protocol/internet protocol connection is established between the user and server, resulting in a hypertext transfer protocol request of information. -Can open in different ways, such as in a popup window or by replacing the content of the original window. -Can be generated automatically, such as with alerts, or accessed manually.

System elements to be tested: User interface

-allows interaction between the user and the machine, permitting the user to make input and to see output as a result. -must consider the needs of the user and ease of use ---Types of current and new interfaces include the following: Touch screens and touch user: Often use din simulations, the device has a combined use of input and output Graphical user: This allows an interface between devices, such as the keyboard and computer. it includes object-oriented user interface as well as application-oriented interfaces. Gesture- This allows input from gestures and mouse/stylus movement Zooming: This allows changes in scale of output Voice user: Input is by keystrokes or voice commands, and output is by voice commands. Natural language: this allows input by keystrokes in natural language, and output is the response Zero-input: input drives from sensors.

Testing methods: Systems environment

-assessed through analysis of the internal environment and external environment. -A needs assessment may be required to determine the type of data required. Data may be derived from the following: >> Published material >> Vendor material >> Organization input >> Regulatory requirement >> Accreditation requirements >> Marketing Trends >> Interviewed and >> Technological Trends Data are analyzed to identify trends, needs, and expectations. Once potential actions or solutions to problems are identified, they must be further analyzed and comparisons made, considering the needs of end-users. After implementation of a system, ongoing testing, analysis, and feedback are necessary to ensure that needs are net and that the system functions effectively.

Steps in conducting a market analysis

-completed to determine both the current status of the market for a product or service and the future potential. Includes assessment of the following: 1. Size of the market and demand 2. Market trends 3. Growth rate of the market 4. Opportunity assessment 5. Profitability 6. Cost structure 7. Methods of distribution 8. Necessary factors

Computer system Integration

-decode information between separate systems. Advantage of having integrated systems is that information is automatically transferred between the various independent systems that make up the parts of the integrated system. This results in a more robust, less error prone, combined system. There ae -Two major types: 1. Point-to-point: connects two separate systems directly to each other. 2. Software reliance systems-For systems that need to interface with more than two entities, it is best to use an interface engine software. This result in a more flexible network. Interface engine software can process information in real-time or in batches. Real-time processing means that information is transferred from one system to another immediately. Batch processing occurs at the end of the day when all information is transferred at one time.

Discuss how user adoption surveys can assist in the evaluation of a newly implemented system.

-determine the type of information that is needed -collaboration with end-users so that users needs are fully understood -be specific and may be targeted to specific groups of staff, so a number of surveys may be necessary to evaluate implementation. -results should be quantified and reviewed to determine if patterns emerge -Patterns should be targeted for intervention through modifications in the system or additional training of the staff members.

Discussed the human-computer interaction framework

-developed by Nancy Staggers in. 2001 -applies concepts related to psychology and technology to explain human interactions with computers over periods of time and different contexts. Different context include: Provider, patients, Interaction between patient and providers. Communication is the basic exchange of human computer interactions. The basics test to accomplish this exchange including initiating, interaction, responding, providing information, and exchanging information. The primary focus of the framework is usability related to human performance during interactions with computers and different contexts, such as overall ease of use, difficulty in learning, efficiency, satisfaction, the ability to carry out error-free interactions, and the ability of the. computer system to match the tasks. Another focus is the. mental model of users, the idea that the. response of users to computer. is based on previous knowledge and experience. In order to be successful in tackling complex computer tasks, the mental model should be. consistent with the concept or design of the computer program; thus, the goal is to find design that promotes an effective mental model.

User-model studies: Usability or ease of use

-important aspect of human-computer interaction (HCI), which may encompass a variety of elements, such as screen layout and navigation. -Consist of three primary goals that should be addressed: effectiveness, efficiency, and satisfaction. -There are many different approaches to usability studies, but studies have indicated that large-scale studies can often be replaced with small-scale studies with 5-8 participants. Practice with prototypes, even on paper, can yield valuable insights. -Participants using the prototypes are encouraged to "think aloud" and talk through procedures, while observers write down the observations. This can help to determine the ease of use of equipment or software and the amount of training needed for effective use. Evaluation by trained experts can also effectively highlight usability problems. -Heuristic (rule of thumb) evaluation or inspection methods have been developed to help guide the evaluation process. Measures of user perceptions include asking participants to assign usability ratings, noting comments during use, and administering questionnaires about satisfaction and workload.

Assignment of Resources

-involves understanding the types of resources available-educational, personal, financial, and equipment-as each must be allocated, using different priorities; therefore, establishing a list of priorities for each category of resource is essential

System elements to be tested: Features

-may relate to data, hardware, software, end-users, and telecommunication and facilitate the four primary functions of an information system: allowing input, providing storage, and providing output -may include the following: >> Management of database >> Ability to generate reports >> Ability to integrate with other components of a system and scalability. >> E-mail and other customizable alerts >> Time keeping/login and logout times >> Communication among different levels and multisite capabilities >> Real-time processing >> Ability to establish uniform procedures >> Ability to provide feedback

Data Conversion/Migration

-occurs when data are translated from one format to another. During implementation of a new system, data migration must occur for the new system to use legacy data but may also occur during system hardware/software upgrades. Migration usually requires software as well as manual effort. Primary states to migration of data: 1. Planning stage: This includes inventorying the system, reviewing the type and amounts of data to be migrated and the source and destination formats, determining the most cost-effective method, making a specific plan for conversion, performing mapping, and creating conversion scripts and specification documents. 2. Performance stage: This includes generating baseline backup of all data, extracting data from the source, normalizing data, performing trial and test conversion, and completing data migration. 3. Validation stage: This includes checking to ensure data were converted accurately and completely with all data elements formatted correctly, eliminating duplication data, and resolving problems.

How system performance can be monitored using performance reports

-provide quantifiable data to show how resources are being utilized to achieve system objectives. -2 typical Types 1. Status reports- describe processes or duration needed to carry out certain tasks and current cost 2. Progress report- list tasks accomplished during a specific period of time.

Individuals who should be included on the steering committee of an information systems implementation

-representatives from all areas of the organization, including: Hospital administration- in order to assure that business processes are maintained. Finance- To assure that billing and patient records are maintained, in addition to establishing a budget. Nurse administrators- To facilitate that nursing procedures are compatible with the new system. Director of the information system department- To oversee that the system is installed properly. Medical records- To assure that record keeping is accurate and follows all regulatory requirements

Overview of the system implementation strategies

-should begin early with preparing stuff and users for the change -and implementation committee should be form before purchases of the system to assess need ensure that the changes meet the mission of the Organization -develop a project plan and timetable -Committee members should be educated about the system so they can serve as resources during that extensive training that needs to occur before implementation -factors to consider during selection include the currency of the technology, ability to upgrade, and issues related to obsolescence, vendor history, vendor compliance with regulations, ability to integrate with existing or other systems, flexibility, support of the electronica health record, and the computer data source. -hardware analysis includes network infrastructure, types of workstations/ Devices, hardware locations, and printing capabilities and location

Process diagram: Data-flow diagrams

-show how data flow into a system and from one process to another, presenting a graphic representation of a system and its processes. The diagram is a simplified flow chart that uses only four symbols, which are labeled during diagraming: >> Square: external entity or sources of data or external destinations. An entity is named. >> Rounded rectangle: process inputting and outputting data. This is named with verb and object. Data flow is from left to right and top to bottom. Each rounded rectangle represents only one process (so "and" is not used). >> Arrow (line with arrowhead): direction of data flow. Arrows are named (but do not include the work "data") >> Three-sided open rectangle (electronic or physical data storage): Open rectangles are named and numbered (but do not include the work "file".) If more than one system shares a data store, then a solid stripe is placed on the left side of the rectangle to indicate this.

Analysis of system performance effectiveness: sanity

-this is rabbit run through testing to determine if results seem reasonable and the system appears to work correctly. This type of testing may be done during development and before more rigorous testing to find. obvious faults.

Analysis of system performance effectiveness: installation testing

-this tests procedures needed to install, uninstall, an upgrade applications. All configurations should be tested, including installing on various types of equipment.

Analysis of system performance effectiveness: exploratory

-this type of testing uses the results of previous testing to determine the type of additional testing indicated, based on user experience, and does not follow specific pattern of testing. This may be done after conclusion of other tests to verify that no significant defects remain.

purpose of conducting a Feasibility study

-used to define the problem(s) that the new information system is expected to address. It will also answer question regarding cost, goals, and specific outcomes. Some specific question 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?

Items that should be included in a RFP

1. A description of the organization 2. Organizations mission statement, goals, and objectives 3. The organizational structure 4. The type of healthcare facility 5. The proportion of clients in each pay type 6. The patient and facilities statistics 7. The overall system requirements 8. The criteria for evaluating responses 9. The deadline for submission of the requested information

User-modeling studies: Performance testing to assess for error

>> Time needed to complete a task, including both the speed and reaction time. >> Percentage of completed and incomplete tasks and the percentage completed correctly >> Number of errors and types of errors >> Time spent in each component/option as well as frequency >> Time spent in training >> Overall quality of completed test >> Time needed for system setup or installation and ease or complexity >> User description of problems encountered and "think aloud" comment during tasks >> Degree of application usage in real work environment as opposed to testing >> Observations of user response and behaviors, including facial expression, actions, and eye tracking >> Amount of time spent on the internet and the number of hits.

System elements to be tested: Components

>>software applications, -which need to be integrated into the other software of the information system. >>Testing is completed to determine if the software meets specifications and functions properly and whether it needs interactions requirements of the system. >>Test verify if specific area of code worked correctly. >>Factors to consider into the ease with which the software functions can be observed, behavioral traceability, the difficulty or ease of functions and operations, and the method that the components used to provide or present information. >>Components may be tested by the developer and by the user, but the user may lack their source codes necessary for effective testing. >>In some cases, if software is functioning well, further testing may not be in indicated. in general, those components should be tested include reusable and domain components. Commercial components are often reusable and should be tested and evaluate for liability issues. When possible, reusable testing strategies should be developed.

Discuss requirements of system issues management

A number of different criteria must be considered for effective system issue management: 1. Technical: type of architecture, downtime necessary for maintenance, standards for connectivity, environments for testing, response times, and supporting technologies. 2. General/managerial: Security standards, data standards, options for storage, capabilities relate to providing reports, integration with health information exchanges. 3. Registration: Correct client identification with unique identifiers across multiple registration sites and ability to track client's location and use of services. 4. Computerized physician order entry reporting: Indicates details about orders, provider notification of duplicate orders, produces audit trail, supports documentation, generates claims, providers clinical decision support, and displays results. 5. Integrated documentation: Pulls documentation from various department 6. Scheduling: Appointments, testing, and procedures 7. Medical Records: Provides automatic coding 8. Billing: Provides summaries, insurance information, and charges.

Automated documentation

Advantages include increased productivity due to: -decreased in cost, error, and omissions -improved care and communication -Easier access to patient information Paper documentation has been transformed in several different ways on a computer system including -narrative charting: similar to traditional nursing documentation. It uses menu selections or text entry fields. Charting by exception: allows the nurse to view normal values and change only those values for which the patient does not conform to the norm flowsheet charting: make use of a graphical user interface to allow the nurse to enter information from a selection of menus. standardized nursing languages: use nationally and internationally defined codes to enter information free from ambiguity.

Testing method: Unit/component (suitability testing methods)

Black box- This is a form of functional testing that determines if an input results in the correct output, using test cases focused on the system's operational profile. This type of testing does not require knowledge of code or inner product design. Testing may not include activation of all codes, so it may not detect all faults. Fault injections- This introduced faults into the system to show what happens to the system when the component fails to function properly. Operational system- This tests the ability of the system to function after introduction of a component. However, this may require a huge amount of testing to determine how the system will deal with component failures or problems. Defense building- Wrappers are used to limit the component software in some way; this is, the wrapper may check or limit input into the component or check or limit output to the system. Wrapper are often employed when commercial software is purchased that only partially meets requirements.

Programming algorithms: Parallel and Distributive

Breaks up the algorithm into parts that can be solved on different machines and then brings the separate answers together for the results.

The classification of programming algorithms: Reduction

Changes the problem into a simpler problem.

Expert Systems

Computerized advisory programs that imitate the reasoning processes of experts in solving difficult problems. May use simple True/False Logic or Fuzzy Logic

Disadvantages of an Expert System

Disadvantage of an __________________ - The software lacks "common sense" - The logic is "locked down' - Programming difficulties - Not adaptable

programming languages

Divided into five separate generation based on how closely they mimic human language. 1. Binary- mahcine language made up of two symbols that signify off (0) and on (1). 2. Assembler language-uses English letters and symbols but relates them directly to binary. makes them difficult to learn. 3. 3rd generation- FORTRAN, COBOL, Java, and Visual BASIC are examples of third generation- FORTRAN and COBOL are procedural languages that require the user to specify both the exact procedure to be carried out as well as the data involved. Java is used for internet content and Visual BASIC is a visual programming language. 4. 4th generation- most people interact with today. Allow users to choose procedures from a menu instead of having to specify them with code. 5. 5th generation- allows user to speak directly to the computer and have them carry out the verbal command.

Discuss common problems seen when managing system issues

During the implementation stage of a new system and conversion of data, a number of common problems may occur, including the following: >> Inadequate allocation of time and resources needed to implement a new system. >> Frequent changes that require programming revisions and result in both scope creep and feature creep with added costs in terms of time and finances. >> Underestimation of the amount of customization required to implement a system and convert data. (One solution is to resist all customization and another, to fully customize. ) >> Failure to budget or plan for service contacts, updates, technical support, power needs, and ongoing operating costs. >> Inadequate testing of all components and the systems, resulting in problems with conversion. >> Failure to understand the need for for training and inadequate resource allocation for training and training materials. >> Failure to assess user resistance accurately or build support for system changes.

System elements to be tested: Reports

Information systems provide a number of different types of reports, and these should be assessed for accuracy. Some reports are generated automatically, and others require manual input to define the type of report and information needed. Types of reports that may be available include: >> Configuration: These reports contain data about the system itself, including hardware and software, as well as workstation and servers. Configuration reports may be generated by systems or data sets. >> Informational: Often informational reports include built-in templates and prove fact-finding to glean information from databases. >> Change: Usually automated, showing changes that occur in the system over a period of time. >> Baseline: Usually automated to show how the system or elements of the system compare to a baseline. >> Summary/Management: These reports show summaries of action, processes, and data. >> Periodic: issued at predetermined periods, such as monthly claims reports. >> Error/exception: issued when faults occurs or data are outside of normal parameters.

The classification of programming algorithms: Linear Programming

Input are restricted based on a predetermined construct.

Three factors that contribute to software usability.

Learnability: The amount of time it takes to learn and figure out how to use the software program. This can be enhanced by the program's help features, documentation, and interface design. Memorability (or efficiency): the amount of time it takes the user to perform tasks without having to stop and look up the instructions or use help features. Software that has been intuitively designed will enhance memorability. Discovery: The time it takes a user to find specific product features in response to the need for that particular feature. This may be enhanced by the similarity of a software product to one that was previously used.

When choosing software, explain the terms: likeability and utility

Likability-how much an individual enjoys using the program Utility- the usefulness of the program

Request for Information (RFI)

Standard business process with the purpose of collecting written information about the capabilities of various suppliers. Normally it follows a format that can be used for comparative purposes. The person requesting should outline the type of information needed and give an overview of plans to purchase and install an information system.

Necessary steps for the formation of an implementation team

Step 1- Select a leader who will own the implementation process Step 2- Form the team with representation from the various users of the system (e.g., IT staff, executives, and nurse). Step 3- To assure success, look for the following team member characteristics: --Good communication skills --Can multi-task effectively --Good cooperation in the team environment Step. 4- Keep the team focused on the final goal of implementing an effective system.

Steps needed for human-centered design

Step 1: Define and understand the organization's requirement and the requirements of the individual user. Step 2: Define and understand the logistic of how and where the system will be used. Step 3: Perform a functionality analysis. Specific system tasks should be broken down by priority, duration, frequency, and probability of completion. Step 4. Define the key system functions. The system functions should be logical and intuitive to the end users. Step 5. Perform and analysis of the most common potential errors that could occur during tasks. Minimize the likelihood of committing errors by optimizing processes. Step 6. Design interfaces and workstations so that they will work best with the users. Step 7. Perform system testing with actual users. Depending on the results of these tests, the system should be adjusted to create the best system for the users.

Steps necessary for upgrading or implementing information systems

Step 1: Planning and administration of the project: Establish the planning and project team, and set the key milestones for the project. Step 2: Delivery of hardware and software: Select the vendor and purchase the hardware and software. Step 3: Program installation: Provide time for installation and perform a qualification (system testing, interfaces to the database, etc.) of the newly installed components. Step 4: Policies and procedures: Develop and approve the relevant policies and procedures. Step 5: Training: Provide training for all relevant personnel. Step 6: Maintenance and support: Set up a maintenance and user support procedure.

Five Logical steps of computer programming

Step 1: Problem definition: also called function specification. The problem (or function) must be defined in detail. All contributing information necessary for solving the problem must be outlined. Step 2: Problem design: Provide the functional specification: Identify what the program will do (input/outputs). Provide design specifications: Specific instructions for the programmer to follow. Step 3: Program preparation: The code is written in a programming language. Documents (including instructions for the user) are prepared. Step 4: Program testing: Alpha testing (also know as disk checking) is carried out by the programmers and system analyst. Beta testing (real world user testing) is carried out to check for accuracy and sufficiency. Step 5: Program implementation: Trained users test the full program (including all logical sub-routines). Programmers troubleshoot uncovered problems before the program is released.

Steps involved in the back loading of existing data

Step 1: describe what information needs to be migrated to the new system Step 2: Establish who is responsible for entering the existing data into the new system Step 3: set a schedule for the timing of the data transfer Step 4: Establish the timeframe for migration of historical data Step 5: Implement controls sure that all back loaded information is accurate Step 6: Verify that the system is working properly

The creation of standard operating procedures (SOPs) and user manuals for an information system

Step one: the standard operating procedures and user documentation should be prepared and used to train users before the system goes live Step two: the documentation that was used to operate the old system should be evaluated for applicability to everything is system Step three: disaster recovery document should be prepared in the event the system "crashes" or goes down. A paper-based system should be readily available. Step four: the vendors user guides and support documentation should be reviewed to determine if the information could be incorporated in the organization's user documentation.

Analysis of accessibility

Testing is completed to ensure that the system is in compliance with the ADA requirements. This includes testing speech recognition software, screen magnifying software, video captioning, braille readers, amplification systems, alternative keyboards, and screen readers to determine if they function properly through various actions. Technical compliance with requirements of the Federal Electronic and Information Technology Accessibility and Compliance Act (1997) must be tested where applicable. Testing should also be done to ensure that internet access is in compliance with standards set by the Web Accessibility Initiative (WAI), which provides guidelines to allow those with disabilities to access the internet and create content.

List some anticipated problems that may occur during implementation of a new system.

The following problems may occur when introducing a new information system into a healthcare facility: -Failing to allocate adequate time for system application -Scope creep: allowing the project to exceed the original scope. This tends to occur slowly during the conduct of the project and ultimately results in exceeding the budget and /or timeline. -Allowing programmers to customize a system beyond what is necessary -Not allowing enough funds for maintenance -Encountering organizational resistance to change the cause roadblocks or delays. -Not allowing enough time to adequately test the system -Not allowing enough time to train relevant staff

Programming algorithms: Logical

Uses the controlled dedication of axioms. Algorithm + logic + control

User-modeling studies: Assessing types of errors

With input, errors may occur during intention to carry out actions, the sequence, or the execution. With output, errors may occur in perception, interpretation, or evaluation: Low Level: Error execution of steps interfere with outcomes, and misunderstanding of outcomes interferes with perception. Moderate level: The sequence of actions results in input that is not compatible with the computer or the mode results in misinterpretation of input. Output is misunderstood or misinterpreted bc lack of training or education. High Level: Interference with intention occurs bc of an inability to make a decision regarding a correct action or an inability to evaluate and interpret outcome correctly.

Explain issues related to instructing and advising staff on changes in policies, procedures, or working standards.

quality professional is responsible for educating the staff about changes related to processes, which should be communicated in an effective and timely manner. >> Policies are usually changed after a period of discussion and review by administration and staff, so all staff should be made aware of policies under discussion. Preliminary information should be disseminated to staff regarding the issue during meetings or through printed notices. >> Procedures may be changed to increase efficiency or improve patient safety often as the result of surveillance and outcome data. Procedural changes ae best communicated in workshops with demonstrations. Posters and handouts should be available as well. >> Working standards are often changed because of regulatory or accrediting requirements; this information should be covered extensively in a variety of ways; discussions, workshops, and handouts so that the implications are clearly understood.

efficacy studies

studies that compare a series of cost-benefit analyses to determine the intervention with the best cost-benefit