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Informatics Program Needs Assessment
Jennie Do Carmo
School of Nursing, Liberty University
Author Note
Jennie Do Carmo I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Jennie Do Carmo
Email: jdocarmo@liberty.edu
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Abstract
The disparity in mental health access in rural communities leaves a need for telehealth. There are
several crucial steps that must be followed in order to implement a successful telehealth program
which patients will utilize. Having a team leader that understands the crucial steps is necessary in
operationalizing a telehealth program. Healthcare agencies have used telehealth in the past but
the Covid-19 pandemic has placed stress on the need for continual healthcare access and placed
urgency on the implementation of improved telehealth systems.
Keywords: telehealth, mental health, Covid-19
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Informatics Program Needs Assessment
Technology is constantly evolving, which forces healthcare to advance continually.
Planning and implementation of a new informatics system in healthcare requires delicate and
meticulous planning. The planning stage must be overseen by a project manager responsible for
the strategic vision and alignment of the informatics program (Nelson & Staggers, 2018). Goals,
objectives, measures, and assignments must be set based upon the community's needs when
operationalizing a telehealth system (2018). The need and implementation of telehealth programs
have increased since the Covid-19 Pandemic (Munshi & Vahia, 2020) to assist with providing
care to communities. Rural citizens are more likely to prematurely die from cancer, heart disease,
and respiratory disease than those living in urban areas. The need for telehealth increases due to
the increased risk of premature death (U.S. Department of Health & Human Services, 2020).
Needs Assessment
The first step in operationalizing a telehealth system is defining the patient population
and the healthcare problems in which the telehealth program is planned to affect (Nelson &
Staggers, 2018). Once the patient population and the current issue are defined, a strength,
weakness, opportunity, and threat (SWOT) analysis must be conducted on the previous system.
The system analyzed must have detailed specifications in order to thoroughly analyze the need
for the system.
Telehealth in Rural Communities
Currently, telehealth has been implemented across the country to provide better access to
the prevention and management of chronic diseases (U.S. Department of Health & Human
Services, 2020). The Center for Disease Control and Prevention (CDC) has implemented
telehealth stroke services in small rural hospitals to improve access to specialists in stroke
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centers (2020). In 2012 the CDC implemented a three-year telehealth diabetes program in which
rural clinic patients in eastern Montana could participate in diet and blood sugar programs
(2020). While telehealth has been implemented in rural communities to address some of the most
common health disparities, Covid-19 has increased the need for mental health strategies to
address the increased amount of substance abuse, overdoses, and mental health stress in rural
communities (Stack et al., 2020). The increase in mental health distress has exposed a lack of
access to mental health care and, therefore, an increase need for telehealth (Munshi & Vahia,
2020).
SWOT Analysis of Current Telehealth Access
The CDC has utilized telehealth since the early 2000s (U.S. Department of Health &
Human Services, 2020). Covid-19 has increased the use of telehealth over the past two years and
forces healthcare to assess where telehealth should expand (Munshi & Vahia, 2020). In-person
Covid restrictions have decreased and healthcare has been allowed to return to in-person
services, yet telehealth remains an option to provide care (2020). Some strengths of telehealth
medicine are ease of access, the ability to tailor to a patient's needs, and technological access
(2020). Patients can receive therapy from the comforts of their homes. A weakness of telehealth
is lack of quality, depending on the available internet connection of the patient. A viable solution
or opportunity would be an initial consult that would assess the internet connection and the
ability to communicate via telehealth. Education of healthcare providers on the utilization of
telehealth would be an issue with the implementation of telehealth. Some providers are not
comfortable setting up confidential meetings and do not know what technology to use. A SWOT
analysis helps guide the future process of implementing new telehealth programs for mental
health access.
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Staff Involvement
In order to operationalize a new informatics system such as a telehealth system, frontline
staff has to express their experiences and thoughts on the current and future process (Nelson &
Staggers, 2018). Part of the needs assessment would be to interview staff and observe staff
utilizing the old and new systems. This takes time to collect the appropriate amount of data. This
data can also be incorporated into the SWOT analysis of the old system. The interviews and
observation of staff also allow for the specific data needs to be defined. The information gathered
from the staff should also be incorporated with the hospital standards and the regulatory
requirements set by The Joint Commission (2018).
Develop Dataflow Maps
Once the SWOT analysis and information from the staff have been gathered and the
operational needs have been defined, a workflow map should be designed (Nelson & Staggers,
2018). A dataflow map or workflow map defines the steps followed during the work activities to
follow a path to the desired outcome (2018), which helps future users of the telehealth system.
Depending on the process, some dataflow maps are more complicated than others. Data flow
maps also help define what areas will be affected by the implementation of the system. Each
dataflow map must incorporate its users and the location of the users. Since the implementation
of telehealth in rural communities is the primary focus, there is no need to incorporate different
units of the hospitals, but different clinics should be considered.
A definition of the affected population, SWOT analysis, staff interviews, and data flow
maps take time to construct. Each project can take months to years to complete; luckily,
technology speeds up the process. There also have to be different levels of administrators to
ensure the completion of each stage. If each assignment has a team leader, the projects can occur
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simultaneously and team leaders can frequently meet to share the data. On average, it takes
around 23 months to implement a new telehealth system while following all the necessary steps
(American Medical Association, 2020).
Theory Framework
When implementing any telehealth program, four components must be considered;
bandwidth, education, leadership, technology (BELT) (Nelson & Staggers, 2018). This is
referred to as the BELT framework. The bandwidth of telehealth is the information transmission
and connectivity to move and store clinical data (2018). Education is the preparation of staff and
workforce utilizing the technology, including creating competencies (2018). The operationalizing
of telehealth technologies involves all levels of management in order to successfully implement
policy and procedure (2018). Technology is the base of any telehealth process and creates
numerous considerations in operationalizing telehealth (2018).
The BELT framework is essential to implementing telehealth but is not the foundation
framework. The Nelson Model is the framework for knowing when and how to use knowledge in
managing patients’ problems or needs (2018). The Nelson Model incorporates wisdom,
knowledge, information, and data to classify different levels of computing (2018). Data involves
collecting and organizing. Information involves organizing and interpreting. Knowledge involves
interpreting, integrating, and understanding. Wisdom is understanding, applying, and utilizing
compassions to integrate everything into the service of the patient (2018).
Role of the Informatic Nurse
During the pre-implementation, implementation, and post-implementation phase,
consistent team members are the ones that advise and oversee the goals, progress, growth, and
budget of the project (Nelson & Staggers, 2018). The team members should consist of an
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executive team and the second management level (2018). The executive team includes hospital
administrators, clinical directors, and the director of information technology (2018). The second
management level includes the project manager, clinical champion, telehealth director, and
system administrator (2018). The role of the informatics nurse can be the project manager,
project educator, or clinical champion. If the role of the informatics nurse is the project manager,
then the job of the informatics nurse is to lead the effort to implement the telehealth program.
When educating telehealth users, an informatics nurse has to spend time demonstrating and
addressing concerns. Education plays a vital role in any operational process, and the informatics
nurse is at its helm. The informatics nurse must ensure that everyone is comfortable with the new
system and address any issues. The clinical champion is usually a physician (2018) but does not
have to be. The clinical champion raises any issues, educates the team members operationalizing
the process, and is the clinical expert. No matter what role the informatics nurse is assigned, they
are a large part of implementing any informatics process.
Conclusion
The impact of Covid-19 on mental health and substance abuse has left healthcare
exploring the need for increased healthcare access (Stack et al., 2020). Implementing more
telehealth programs for easy access to mental health programs allows rural communities to
decrease substance abuse and overdoses. The need for easy access and thorough mental health
telehealth programs is apparent but requires meticulous planning. Staff input must be considered
and a team leader assigned for a telehealth program to be successful. The role of the informatics
nurse and the implementation of the BELT framework is vital to the success of a telehealth
program. “Whatsoever thy hand findeth to do, do it with thy might” (King James Version,
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1611/2017, Ecclesiastes 9:10). Creating and following any process is time-consuming but is
rewarding in the end.
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References
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association. Retrieved November 21, 2021, from https://www.ama-
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King James Bible. (2017). Thomas Nelson Publishing. (Original work published 1611)
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https://hbr.org/2020/12/psychiatry-is-revealing-the-potential-and-pitfalls-of-telehealth.
Nelson, R., & Staggers, N. (2018). Health Informatics: An interprofessional approach. Mosby.
Stack, E., Leichtling, G., Larsen, J. E., Gray, M., Pope, J., Leahy, J. M., Gelberg, L., Seaman, A.,
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communities. Centers for Disease Control and Prevention. Retrieved November 21,
2021, from
https://www.cdc.gov/chronicdisease/resources/publications/factsheets/telehealth-in-rural-
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