NEEDS ASSESSMENT 1
Informatics Needs Assessment
Monica D. Sleboda
School of Nursing, Liberty University
Author Note
Monica D. Sleboda
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Monica D. Sleboda
Email: mdsleboda@liberty.edu
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Informatics Needs Assessment
This paper will cover the needs of ABC Corporation with selecting a new electronic health
record (EHR) since their current program has become outdated. It will also cover the theory
framework that will support the need as well as the role of the informatics nurse in fulfilling the
need. To determine which system will work best for ABC Corporation a needs assessment will
need to be conducted first, which entails three main parts: initiation, data collection & analysis,
and final product (Weisberg, 2019). A Needs Assessment will allow for the identification of the
actions and processes needed to function more efficiently as well as identify and determine how
to bridge the gap between the organizations current state and their desired state. (Indeed
Editorial Team, 2021; World Health Organization, n.d.).
Initiation
During the initiation phase, it is important to identify any limiting factors of the current EHR
in use. To do this it is important to determine what issues there are and where the company wants
to go with the new system, this may also be called a Gap analysis. A Gap analysis is used to
identify what is happening with the current EHR system compared to what the desired outcome
is with a new EHR system; the “what is” compared to the “what should be”. To start the Gap
analysis, the informatics nurse would want to review the current information systems that are in
place and their functionality (Nelson & Staggers, 2018) and determine where the organization is
wanting to go with the new system.
Data Collection & Analysis
During the data collection and analysis phase it will be important to interview staff from
various departments within the hospital to elicit their opinions and experiences with the current
system as well as determine needs for the new EHR system (Nelson & Staggers, 2018). It may
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be useful to incorporate the SWOT (strengths, weaknesses, opportunities, threats) analysis tool
during this phase. Use of the SWOT analysis tool will allow for the identification of any:
Strengths of the current system, such as, useful features and functions and ease of use.
Weaknesses, such as features that are not liked or difficult to use.
Opportunities, such as features or functionalities that are missing from the current system
that may be helpful from the new system.
Threats, which may include security threats or threats to patient care due to system
shortcomings (Nelson & Staggers, 2018).
Other insightful opportunities during the data collection and analysis phase would be to
collect current samples of system and manual reports to identify reporting needs for both hospital
management and government entities, patient care objectives, IT department objectives, and
vendor evaluation. Important consideration should be given to data and reports that support the
hospital in meeting regulatory and accreditation requirements as well as payor requirements
(Nelson & Staggers, 2018). Patient care objectives should include determining the types of
patient data to be entered as well as specific areas of the hospital which treat specialized patients
and therefore require specialized processes, such as the ER, NICU, and OR (Nelson & Staggers,
2018). IT department objectives would include any specific customizations that would need to be
accomplished with the new system as well as meeting regulatory requirements, such as the
meaningful use certification outlined by the HITECH Act (Nelson & Staggers, 2018). Finally,
vendor evaluation would need to be performed to ensure that vendor systems would work
cohesively with the new system.
Final Product
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The final phase of the Needs Assessment is the final product phase. This is where a summary
of findings is produced to include any strategies that will cover the strengths and weaknesses of a
new EHR (Weisberg, 2019) as well as any recommended changes that should be made in practice
in relation to documentation. Recommended changes may include report generation changes,
documentation changes, and update changes, depending on the type of system that is selected.
Theory/Framework
Change theory would be the model used here since this process would be a big change for all
the users of the new EHR system. Change theory focuses on rejecting prior knowledge and
replacing it with new information (Udod et al., 2018). It was first developed by Kurt Lewin and
contains three stages of change: unfreezing-moving/change-refreezing (Petiprin, 2020; Udod, et
al., 2018) which are driven by driving forces, restraining forces, and equilibrium.
Unfreezing Stage
The unfreezing stage is when an individual must let go of what they know and replace it with
new information. During this phase is where the largest shift between driving forces and
restraining forces occurs. Driving forces push in a direction that causes the change and
restraining forces are those that attempt to prevent the change (Udod, et al., 2018).
Driving Forces
Driving forces are defined as those which “push in a direction that causes a change to occur
or that facilitate the change because they push a person in a desired direction” (Udod et al.,
2018). In this case, the driving forces are the outdated EHR system that no longer provides the
support that the corporation needs to function. However, getting staff on board with the change
can be a little more difficult. Therefore, it would be important for management to point out to
users the limitations of the current system and benefits of the new system. By getting employees
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excited about a new system would be a driving force to the planned change. This is also known
as the unfreezing stage because management is finding ways to get their staff to let go of the old
ways of doing things by breaking down the restraining forces.
Restraining Forces
Restraining forces are those that prevent the change from occurring (Udod et al., 2018).
Restraining forces may include individuals who are comfortable with the current system and
therefore do not want to see a change be made. They make their voices heard to other staff who
then begin to feel the same way and push against the change as well. It is important to find ways
to have staff buy into the change. One such way is by involving some of these staff in the
interview process before any decisions have been made so they feel as if their concerns have
been heard and acted upon. “Asking for user input early in the process before decisions have
been made can decrease the restraining forces” (Nelson & Staggers, 2018, p. 29).
Equilibrium
Equilibrium is a state of pure balance. Both driving forces and restraining forces are equal
and no change occurs (Petiprin, 2020). Depending on the level of driving forces or restraining
forces the equilibrium can be raised or lowered (Petiprin, 2020). That is why it is difficult to stay
in equilibrium for long, because there is constant change, whether planned or unplanned.
Moving/Change Phase
During the moving/change phase an individual experiences a change in thoughts, feelings,
and/or behaviors (Petiprin, 2020; Udod, et al., 2018) and can be the most difficult. Udod, et al.,
(2018), insists that “this level is often the most difficult since there is a level of uncertainty and
fear associated with change” (para. 10). During this phase of the change process, it will be
helpful to have a support team present to facilitate achieving the desired outcome and to help
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alleviate any fear or anxiety related to the change. It is also important during this phase to
recognize and identify system processes and procedures that need to be modified and to act on
them quickly to reduce risk of refreezing a bad procedure (Nelson & Staggers, 2018).
Refreezing Phase
The final phase in change theory is the refreezing phase. During this phase, an individual is
establishing the new habit where it becomes second nature to perform, and the entities involved
enter into the maintenance phase of the project (Nelson & Staggers, 2018). This stage is
necessary to ensure that the change is implemented and will stick, therefore, creating a new
equilibrium (Udod et al., 2018).
Role of the Informatics Nurse
The role of the informatics nurse can be summed up using the Staggers and Nelson Systems
Life Cycle Model which includes analyzation, planning, development, testing,
implementation/go-live, maintenance and evaluation (Nelson & Staggers, 2018). At first, a
thorough analysis of the current system would need to be performed to see where the issues lie.
During this time, the informatics nurse could work with current staff to find out what the issues
are that they are having with the system. This could include observing users interacting with the
current application or in specialty areas or conducting focus groups to determine needs (Nelson
& Staggers, 2018). The planning phase will require the informatics nurse to work with the
existing IT department to ensure that all existing vendors are consulted to ensure compatibility
with any new system that is developed, purchased, or designed. The development or purchase
phase will require the informatics nurse to determine any special tailoring that needs to be done
to the system based on the feedback obtained from end-users during the analysis stage. Training
will begin to be developed as well. In the test stage, the system is tested extensively for any
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issues that may be encountered no matter where the system is used. This would also be a good
time to bring in designated super-users to work with the team to decide on any needed changes
prior to go-live. Once this has been completed, the next step in the process is the go-live or
implementation phase. During the implementation phase the system is now up and running in the
live environment. At this point the informatics nurse will have a team or super-users to assist
staff with the go-live to reduce anxiety and ensure conformity. This may include, depending on
the size of the organization, a command center to assist with any urgent needs or issues (Nelson
& Staggers, 2018). The maintenance phase occurs generally 90 to 120 days after the go-live and
is now considered routine, normal operations in the IT, clinical, and business areas (Nelson &
Staggers, 2018). The evaluation phase is ongoing throughout all other phases. With each step that
is taken from the beginning analysis phase, evaluations are being performed to determine any
needed changes. This is where an informatics nurse may be their busiest because they are
running through every possible scenario that can occur on a unit and working with specialty
areas to ensure proper functionality of the system as needed.
Conclusion
A Needs Assessment allows an organization to determine where they are currently
compared to where they want to be. Through initiation, data collection and analysis, and final
product an organization can determine what the new system is needing to do in order for
operations to run smoother. By using change theory to facilitate the needed change, the
organization can avoid restraining forces and support the driving forces needed for the change to
occur smoothly. By limiting restraining forces, the organization can go through the three phases
of change theory, unfreezing-moving/change-refreezing without complications. The role of the
informatics nurse during the change is to assist the acquisition of the new EHR along with the
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analysis, planning, development, testing, implementation/go-live, maintenance, and evaluation of
the new system. The major role of the informatics nurse is to support end-users in accepting the
change while also giving feed-back to the organization on implementing changes based on feed-
back received from end-users.
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References
Indeed Editorial Team. (2021). Needs Assessment: Definition, Overview and Examples. Indeed
Career Guide. https://www.indeed.com/career-advice/career-development/needs-
assessment#:~:text=A%20needs%20assessment%20is%20the,organization's%20current
%20and%20desired%20state.&text=A%20needs%20assessment%20will%20help,it
%20effectively%20to%20their%20audience.
Nelson, R., & Staggers, N. (2018). Health informatics: an interprofessional approach (2nd ed.).
Elsevier.
Petiprin, A. (2020, July 19). Lewin's Change Theory. Nursing Theory. https://nursing-
theory.org/theories-and-models/lewin-change-theory.php.
Udod, S., & Wagner, J. (2018). Common Change Theories and Application to Different Nursing
Situations. In Leadership and Influencing Change in Nursing. essay, Press Books.
Weisberg, A. (2019, January 29). How to Conduct Needs Assessment Part 1: What is it and why
do it? NC State Industry Expansion Solutions. https://www.ies.ncsu.edu/blog/how-to-
conduct-needs-assessment-part-1-what-is-it-and-why-do-it/.
World Health Organization. (n.d.). Needs Assessment. World Health Organization.
https://www.who.int/health-cluster/resources/publications/hc-guide/HC-Guide-chapter-
10.pdf?ua=1.
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