Presentation 3
a. Waterfall Model
The waterfall model is one of the oldest methods and literally depicts a
waterfall effect—that is, the output from each previous phase flows into or becomes
the initial input for the next phase. This model is a sequential development process in
that there is one pass through each component activity from conception or feasibility
through implementation in a linear order. The deliverables for each phase result from
the inputs and any additional information that is gathered. There is minimal or no
iterative development where one takes advantage of what was learned during the
development of earlier deliverables. Many projects are broken down into six phases,
especially small- to medium-size projects.
As the term implies, the feasibility study is used to determine whether the
project should be initiated and supported. This study should generate a project plan
and estimated budget for the SDLC phases. Often, the TELOS strategy—
technological and systems, economic, legal, operational, and schedule feasibility— is
followed. Technological and systems feasibility addresses the issues of technological
capabilities, including the expertise and infrastructure to complete the project.
Economic feasibility is the cost–benefit analysis, weighing the benefits versus the
costs to determine whether the project is fiscally possible and worth undertaking.
Formal assessments should include return on investment. Legal feasibility assesses
the legal ramifications of the project, including current contractual obligations,
legislation, regulatory bodies, and liabilities that could affect the project. Operational
feasibility determines how effective the project will be in meeting the needs and
expectations of the organization and actually achieving the goals of the project or
addressing and solving the business problem. Schedule feasibility assesses the
viability of the time frame, making sure it is a reasonable estimation of the time and
resources necessary for the project to be developed in time to attain the benefits and
meet constraints. TELOS helps to provide a clear picture of the feasibility of the
project.
During the analysis phase, the requirements for the system are teased out from
a detailed study of the business needs of the organization. As part of this analysis,
work flows and business practices are examined. It may be necessary to consider
options for changing the business process. The design phase focuses on high- and
low-level design and interface and data design. At the high-level phase, the team
establishes which programs are needed and ascertains how they will interact. At the
low-level phase, team members explore how the individual programs will actually
work. The interface design determines what the look and feel will be or what the
interfaces will look like. During data design, the team critically thinks about and
verifies which data are required or essential.
The analysis and design phases are vital in the development cycle, and great
care is taken during these phases to ensure that the software’s overall configuration is
defined properly. Mockups or prototypes of screenshots, reports, and processes may
be generated to clarify the requirements and get the team or stakeholders on the same
page, limiting the occurrence of glitches that might result in costly software
development revisions later in the project.
During this phase, the designs are brought to life through programming code.
The right programming language, such as C++, Pascal, Java, and so forth, is chosen
based on the application requirements. The testing is generally broken down into five
layers: (1) the individual programming modules, (2) integration, (3) volume, (4) the
system as a whole, and (5) beta testing. Typically, the programs are developed in a
modular fashion, and these individual modules are then subjected to detailed testing.
The separate modules are subsequently synthesized, and the interfaces between the
modules are tested. The system is evaluated with respect to its platform and the
expected amount or volume of data. It is then tested as a complete system by the team.
Finally, to determine if the system performs appropriately for the user, it is beta tested.
During beta testing, users put the new system through its paces to make sure that it
does what they need it to do to perform their jobs.
Once the system has been finalized from the testing phase, it must be
maintained. This could include user support through actual software changes
necessitated through use or time. According to Isaias and Issa (2015), “one common
trait covers all the variations of this model: It is a sequential model. Each of its stages
must be entirely concluded before the next can begin” (p. 23). The main lack of
iterative development is seen as a major weakness, according to Purcell (2007). No
projects are static, and typically changes occur during the SDLC. As requirements
change, there is no way to address them formally using the waterfall method after
project requirements are developed. The waterfall model should be used for simple
projects when the requirements are well known and stable from the outset.
b. Rapid Prototyping or Rapid Application Development
As technology advances and faster development is expected, rapid
prototyping, also known as rapid application development (RAD), provides a fast way
to add functionality through prototyping and user testing. It is easier for users to
examine an actual prototype rather than documentation. A rapid requirements-
gathering phase relies on workshops and focus groups to build a prototype application
using real data. This prototype is then beta tested with users, and their feedback is
used to perfect or add functionality and capabilities to the system.
According to Alexandrou (2016), “RAD (rapid application development)
proposes that products can be developed faster and of higher quality” (para. 1). The
RAD approach uses informal communication, repurposes components, and typically
follows a fastpaced schedule. Object-oriented programming using such languages as
C++ and Java promotes software repurposing and reuse.
The major advantage is the speed with which the system can be deployed; a
working, usable system can be built within 3 months. The use of prototyping allows
the developers to skip steps in the SDLC process in favor of getting a mockup in front
of the user. At times, the system may be deemed acceptable if it meets a predefined
minimum set of requirements rather than all of the identified requirements. This rapid
deployment also limits the project’s exposure to change elements. Unfortunately, the
fast pace can be its biggest disadvantage in some cases.
When adhering to a tightly constrained development schedule, the pace of
progress often outstrips the time available for comprehensive testing, presenting
significant challenges, particularly in the critical area of security.
A constrained development schedule can arise due to various factors, such as
market demands, competitive pressures, or project deadlines. While these timelines
are essential for timely product delivery and staying ahead in the market, they can
inadvertently compromise the thoroughness of testing processes, especially in
complex domains like security.
Security testing, in particular, is crucial yet often susceptible to being sidelined
or abbreviated in fast-paced development cycles. This omission can lead to
vulnerabilities going undetected, potentially exposing systems and users to security
breaches, data leaks, or malicious attacks. The repercussions of inadequate security
testing extend beyond immediate financial costs to include damage to reputation, loss
of customer trust, and legal liabilities.
To mitigate these risks, organizations must adopt proactive strategies. Firstly,
integrating security considerations early in the development lifecycle—through
practices like Secure Software Development Life Cycle (SDLC)—ensures that
security isn't an afterthought but a foundational element from inception. This
approach involves threat modeling, code analysis, and penetration testing throughout
development stages, thereby embedding security into every phase of the process.
Furthermore, automation plays a pivotal role in addressing the challenges of
accelerated development schedules. Automated testing tools and frameworks can
streamline the identification of security vulnerabilities, enhance testing coverage, and
expedite feedback loops. This not only improves efficiency but also enables
continuous monitoring and validation of security measures as the software evolves.
Collaboration between development and security teams is another critical
factor. Establishing clear communication channels and cross-functional collaboration
ensures that security requirements are understood and integrated into development
tasks seamlessly. This partnership fosters a culture of shared responsibility for
security and promotes proactive identification and resolution of potential risks.
Education and training are essential components as well. Equipping
developers, testers, and stakeholders with up-to-date knowledge of security best
practices, emerging threats, and compliance requirements empowers them to make
informed decisions and prioritize security considerations effectively within tight
schedules.
Lastly, regular audits and reviews are indispensable for evaluating the efficacy
of security measures implemented during fast-paced development cycles. Conducting
periodic assessments, vulnerability scans, and risk assessments help identify gaps,
validate controls, and refine security strategies to align with evolving threats and
regulatory standards.
In conclusion, while fast-paced development schedules are essential for
competitiveness and innovation, they necessitate careful consideration and proactive
measures to safeguard against security vulnerabilities. By integrating security early,
leveraging automation, fostering collaboration, and prioritizing education and audits,
organizations can mitigate the risks associated with inadequate testing and ensure
robust security in their software products.
The RAD approach is chosen because it builds systems quickly through user-
driven prototyping and adherence to quick, strict delivery milestones. This approach
continues to be refined and honed, and other contemporary manifestations of RAD
continue to emerge in the agile software development realm.
c. Object-Oriented Systems Development
The object-oriented systems development model blends SDLC logic with
object-oriented modeling and programming power (Stair & Reynolds, 2016).
Objectoriented modeling makes an effort to represent realworld objects by modeling
the real-world entities or things (e.g., clinic, patient, account, nursing or healthcare
professional) into abstract computer software objects. Once the system is object
oriented, all of the interactions or exchanges take place between or among the objects.
In object-oriented programming, classes serve as blueprints or templates for
creating objects. Each class defines the properties (data) and behaviors (actions) that
its objects will have. This paradigm allows developers to organize and structure their
code in a way that models real-world entities or abstract concepts.
Objects, which are instances of classes, encapsulate data (attributes or
properties) and methods (functions or procedures) that operate on that data. This
encapsulation promotes modularity and reusability by bundling related functionalities
together.
One of the key advantages of OOP is inheritance, which enables one class
(subclass or derived class) to inherit attributes and methods from another class
(superclass or base class). This concept facilitates code reuse and promotes the DRY
(Don't Repeat Yourself) principle, as common functionalities can be defined once in a
superclass and inherited by multiple subclasses.
Class hierarchies emerge from inheritance relationships, where subclasses can
further extend or specialize the behavior of their superclass. This hierarchical
structure allows for a more organized and scalable codebase, as developers can build
upon existing classes without modifying their core functionalities.
Moreover, polymorphism, another fundamental OOP concept, allows objects
of different classes to be treated as objects of a common superclass. This flexibility
enables interchangeable use of objects and supports dynamic method binding at
runtime.
By promoting encapsulation, inheritance, and polymorphism, OOP fosters
modular, maintainable, and extensible software development practices. It encourages
developers to think in terms of real-world objects and their interactions, leading to
more intuitive and robust solutions to complex problems.
In summary, the combination of classes, objects, inheritance, and
polymorphism forms the foundation of object-oriented programming, offering a
powerful paradigm for building flexible, reusable, and scalable software systems. This
approach not only enhances code efficiency and organization but also supports clearer
and more natural representation of complex systems and their relationships.
Object-oriented programming (OOP) languages such as C++ and Java are
renowned for their ability to facilitate software repurposing and reuse through well-
designed class hierarchies. This approach, integral to the Software Development Life
Cycle (SDLC), leverages OOP principles to enhance the interactions and functionality
of objects within a system.
At the core of OOP is the concept of classes and objects. Classes serve as
blueprints or templates from which objects are instantiated. By organizing data and
functions into classes, developers can encapsulate behavior and state, promoting
modularity and reusability across different parts of the software.
By adhering to these principles and designing a clear and appropriate class
hierarchy, developers can harness the full potential of OOP languages like C++ and
Java in supporting the SDLC. This approach not only enhances software modularity,
flexibility, and scalability but also promotes code reuse, accelerates development
cycles, and improves overall software quality and maintainability. Thus, investing in
thoughtful class design and leveraging OOP principles effectively can yield
significant benefits throughout the software development process.
For example, in the case scenario, a system could be developed for the
Wellness Alliance to manage the community health programming for the clinic system
being set up for outreach. There could be a class of programs, and well-baby care
could be an object in the class of programs; programs is a relationship between
Wellness Alliance and well-baby care. The program class has attributes, such as clinic
site, location address, or attendees or patients. The relationship itself may be
considered an object having attributes, such as pediatric programs. The class hierarchy
from which all of the system objects are created with resultant object interactions
must be clearly defined.
The OOSD model is a highly iterative approach. The process begins by
investigating where object-oriented solutions can address business problems or needs,
determining user requirements, designing the system, programming or modifying
object modeling (class hierarchy and objects), implementing, user testing, modifying,
and reimplementing the system, and ends with the new system being reviewed
regularly at established intervals and modifications being made as needed throughout
its life.
d. Types of Healthcare Organization Information Systems
Case management information systems identify resources, patterns, and
variances in care to prevent costly complications related to chronic conditions and to
enhance the overall outcomes for patients with chronic illness. These systems span
past episodes of treatment and search for trends among the records. Once a trend is
identified, case management systems provide decision support promoting preventive
care. Care plans are a common tool found in case management systems. A care plan is
a set of care guidelines that outline the course of treatment and the recommended
interventions that should be implemented to achieve optimal results. By using a
standardized plan of care, these systems present clinicians with treatment protocols to
maximize patient outcomes and support best practices. Information technology in
health care is positioned to support the development of interdisciplinary care plans.
Standard 5 in health informatics emphasizes the critical role of documentation
in managing health information effectively. Health informatics professionals are
tasked with understanding not only the content but also the diverse uses of health
information across various healthcare settings and systems. This understanding is
essential for accurately documenting and communicating pertinent information while
adhering to legal and regulatory requirements.
Documentation in health informatics serves multiple purposes. Firstly, it
ensures continuity of care by providing a comprehensive record of patient encounters,
treatments, and outcomes. This record facilitates communication between healthcare
providers, enabling informed decision-making and coordinated care delivery.
Moreover, accurate documentation supports clinical research, quality improvement
initiatives, and healthcare policy development by providing valuable data insights.
Health information documentation must comply with stringent legal and
regulatory standards to protect patient privacy and confidentiality. Professionals in
this field must be well-versed in laws such as the Health Insurance Portability and
Accountability Act (HIPAA) in the United States or similar regulations in other
countries. Compliance ensures that patient information is handled securely and
ethically throughout its lifecycle, from collection to storage and sharing.
Furthermore, effective documentation practices contribute to improved
healthcare outcomes and patient safety. Clear, concise, and timely documentation
reduces the risk of errors and miscommunication among healthcare teams. It also
supports accurate coding and billing processes, which are essential for healthcare
reimbursement and financial viability of healthcare organizations.
In the context of electronic health records (EHRs) and health information
systems (HIS), standardized documentation practices enhance interoperability and
data exchange between different healthcare entities. Standardization ensures that
health information is structured consistently, allowing for seamless integration across
systems and facilitating meaningful use of data for clinical decision support and
population health management.
Continuous education and training are crucial for health informatics
professionals to stay updated with evolving documentation standards, technological
advancements, and regulatory changes. Professional organizations and certification
bodies often provide resources and guidelines to support ongoing professional
development in this dynamic field.
In summary, Standard 5 underscores the importance of accurate,
comprehensive, and legally compliant documentation in health informatics. By
understanding the content and diverse uses of health information, professionals in this
pathway play a pivotal role in supporting quality healthcare delivery, promoting
patient safety, and advancing healthcare practices through effective documentation
practices.
Case management information systems are especially beneficial for patient
populations with a high cost of care and complex health needs, such as the elderly or
patients with chronic disease conditions. Avoiding complications requires identifying
the right resources for care and implementing preventive treatments across all medical
visits. Ultimately, this preventive care decreases the costs of care for patients with
chronic illnesses and supports a better quality of life. Such systems increase the value
of individual care while controlling the costs and risks associated with long-term
health care.
Case management systems are increasingly being integrated with electronic
health records (EHRs). Information collected by these systems is processed in a way
that helps to reduce risks, ensure quality, and decrease costs. A presentation of results
of the 2012 Health Information Technology Survey, conducted by the Case
Management Society of America (CMSA, 2014), revealed several key trends in
information technology, including the increased use of social media and wireless
communications, the use of IT to support care transitions and prevent readmissions,
expanded use of patient engagement technologies (text messaging, email, portals,
smartphone apps), and work toward the integration of case management software into
the EHR.
e. Communication Systems
Communication systems promote interaction among healthcare providers and
between providers and patients. Such systems have historically been kept separate
from other types of health information systems and from one another. Healthcare
professionals overwhelmingly recognize the value of these systems, however, so they
are now more commonly integrated into the design of other types of systems as a
newly developing standard within the industry. Examples of communication systems
include call light systems, wireless telephones, pagers, email, and instant messaging,
which have traditionally been forms of communication targeted at clinicians. Other
communication systems target patients and their families. Some patients are now able
to access their electronic chart from home via an Internet connection. They can update
their own medical record to inform their physician of changes to their health or
personal practices that impact their physical condition. Inpatients in hospital settings
also receive communication directly to their room.
Patients and their families benefit greatly from the implementation of
personalized communication systems within healthcare settings. These systems serve
a multifaceted role beyond simply notifying individuals about scheduled tests and
procedures or confirming menu preferences. They are designed to enhance patient
engagement, streamline care delivery processes, and ultimately improve healthcare
outcomes through various interactive and educational functionalities.
At the core of these systems is their ability to provide tailored messages and
notifications that cater to the specific needs and preferences of each patient. For
example, patients can receive detailed daily schedules that outline upcoming medical
appointments, tests, and procedures. This proactive communication not only keeps
patients informed but also empowers them to actively participate in their care
planning and decision-making process.
Additionally, these systems facilitate seamless communication regarding
dietary preferences. Patients can conveniently confirm their meal choices and any
dietary restrictions, ensuring that their nutritional needs are met during their hospital
stay. This personalized approach contributes to patient satisfaction and supports their
overall well-being and recovery.
Beyond logistical information, personalized communication systems also
serve as valuable platforms for delivering health education messages. Patients and
their families can receive educational content on a wide range of topics, such as
disease management, medication adherence, lifestyle modifications, and preventive
care. For instance, patients may receive personalized advice on smoking cessation
techniques or tips for managing chronic conditions, empowering them with
knowledge to make informed health decisions.
Moreover, these systems promote two-way communication between patients,
families, and healthcare providers. Patients can actively engage with their care team,
ask questions, provide feedback, and request additional information through secure
digital channels. This interactive communication fosters a collaborative relationship
between patients and healthcare professionals, leading to improved patient satisfaction
and better clinical outcomes.
In the realm of digital health solutions, personalized communication systems
are often integrated with electronic health records (EHRs) and mobile applications.
This integration enables healthcare providers to access real-time patient information,
facilitate care coordination across multidisciplinary teams, and support continuity of
care both within and outside hospital settings.
Looking ahead, ongoing advancements in technology and patient-centered
care models will continue to enhance the capabilities and effectiveness of
personalized communication systems in healthcare. These systems will play a pivotal
role in transforming the patient experience, optimizing care delivery processes, and
ultimately contributing to improved health outcomes for patients and their families
worldwide.
As health care begins to introduce more of this technology into practice, the
value of having communication tools integrated with other types of systems is being
widely recognized. Integrating communication systems with clinical applications
provides a real-time approach that facilitates interactions among the entire healthcare
team, patients, and their families to enhance care. These systems enhance the flow of
communication within an organization and promote an exchange of information to
care better for patients. The next generation of communication systems will be
integrated with other types of healthcare systems and guaranteed to work together
smoothly. The Research Brief discusses the economic impact of communication
inefficiencies in U.S. hospitals. As hospitals and physician practices strive to become
more patient centered, communication technologies will be an integral part of this
goal. Many of us have experienced the anxiety of waiting for news about a loved one
during a surgical procedure. Newer communication techniques, such as surgical
tracking boards that communicate about the process, help to ease these anxieties.
Gordon and colleagues (2015) conducted a significant study that highlighted
the positive impact of utilizing a HIPAA-compliant surgical instant messaging system
in healthcare settings. This system was specifically designed to enhance
communication by providing real-time updates on surgical progress to designated
recipients chosen by the patients themselves, such as family members or caregivers.
The findings from Gordon et al.'s research underscored several key benefits
and implications of using such a system. Firstly, high levels of patient and family
satisfaction were observed, indicating that real-time updates regarding surgical
progress can alleviate anxiety and uncertainty among patients' loved ones. This
transparency in communication not only fosters trust between healthcare providers
and families but also enhances overall patient experience during critical medical
procedures.
Moreover, the HIPAA-compliant nature of the messaging system ensures that
patient information is securely transmitted and accessed only by authorized recipients.
This adherence to regulatory standards is crucial in maintaining patient confidentiality
and privacy, which are paramount in healthcare settings.
The study also highlighted operational efficiencies that can be achieved
through the implementation of such technology. By streamlining communication
pathways, healthcare teams can coordinate more effectively, potentially reducing
delays and improving surgical workflow. This can lead to better resource utilization,
enhanced patient safety, and ultimately, improved clinical outcomes.
Furthermore, the use of instant messaging systems in surgical contexts
demonstrates the evolving role of technology in modern healthcare delivery. It reflects
a shift towards patient-centered care models where communication is not only timely
but also personalized to meet the individual needs and preferences of patients and
their families. This approach supports shared decision-making and empowers patients
by keeping them informed and engaged throughout their treatment journey.
Looking forward, the integration of advanced communication technologies
like instant messaging systems is expected to continue transforming healthcare
delivery. Future research could explore expanding the functionalities of these systems
to include additional patient education modules, remote monitoring capabilities, and
integration with electronic health records (EHRs) for comprehensive care
coordination.
In conclusion, Gordon and colleagues' study provides compelling evidence of
the benefits of using a HIPAA-compliant surgical instant messaging system in
enhancing patient and family satisfaction, improving communication efficiency, and
supporting patient-centered care in surgical settings. As healthcare continues to
embrace digital innovations, such systems have the potential to become integral tools
in achieving safer, more efficient, and more patient-centric surgical practices.
While this study focused on the discipline of surgery, we can easily imagine
the benefits of this type of communications application outside of the surgical model
that we have studied. The results of any laboratory, pathology, or radiography studies
can be instantaneously shared with concerned family members all over the globe. In
the critical care setting, doctors can communicate with a patient’s extended support
group more efficiently and in a less stress-inducing environment than the typical
crowded consultation room outside of the intensive care unit. News of the arrival of a
newborn baby boy or girl can be sent to eager aunts, uncles, and grandparents back
home.
f. The Human–Technology Interface
What is the human–technology interface? Broadly speaking, anytime a human
uses technology, some type of hardware or software enables and supports the
interaction. It is this hardware and software that defines the interface. The array of
light switches described previously was actually an interface (although not a great
one) between the lighting technology in the room and the human user. In today’s
healthcare settings, one encounters a wide variety of human–technology interfaces.
Those who work in hospitals may use bar-coded identification cards to log their
arrival time into a human resources management system. Using the same cards, they
might log into their patients’ EHR, access their patient’s drugs from a drug
administration system, and even administer the drugs using bar-coding technology.
Other examples of human–technology interfaces one might encounter include a
defibrillator, a patient controlled analgesia (PCA) pump, any number of physiologic
monitoring systems, electronic thermometers, and telephones and pagers.
The human interfaces for each of these technologies are different and can even
differ among different brands or versions of the same device. For example, to enter
data into an EHR, one might use a keyboard, a light pen, a touch screen, or voice.
Healthcare technologies may present information via computer screen, printer, or
smartphone. Patient data might be displayed in the form of text, images (e.g., the
results of a brain scan), or even sound (an echocardiogram); in addition, the
information may be arrayed or presented differently, based on roles and preferences.
Some human–technology interfaces mimic face-to-face human encounters. For
example, faculty members are increasingly using videoconferencing technology to
communicate with their students.
Telehealth has emerged as a transformative tool for healthcare professionals,
enabling nurses to leverage telecommunication and videoconferencing technologies to
interact with patients remotely, extending care beyond traditional clinical settings.
This approach not only enhances the efficiency of patient monitoring and
management but also facilitates more frequent and effective communication between
nurses and patients in their homes.
One of the primary benefits of telehealth for nurses is the ability to remotely
monitor patients' vital signs and health metrics in real-time. Through connected
devices and wearable technology, nurses can access accurate data on parameters such
as heart rate, blood pressure, blood glucose levels, and oxygen saturation without the
need for in-person visits. This continuous monitoring allows for early detection of
changes in health status, enabling timely interventions and proactive management of
chronic conditions.
In addition to monitoring vital signs, telehealth enables nurses to supervise
wound care remotely. By guiding patients and caregivers through wound dressing
changes, assessing healing progress via video conferencing, and providing immediate
feedback, nurses can ensure that wound care protocols are followed correctly. This
approach not only enhances patient safety but also promotes adherence to treatment
plans, potentially reducing the risk of complications and hospital readmissions.
Telehealth also serves as a valuable educational tool for nurses, allowing them
to demonstrate medical procedures, educate patients and caregivers about disease
management, medication administration, and lifestyle modifications. Through
videoconferencing platforms, nurses can conduct virtual sessions to teach patients
how to use medical equipment, perform self-care tasks, and make informed decisions
about their health. This patient education component empowers individuals to take an
active role in managing their health and promotes continuity of care between clinic
visits.
Moreover, telehealth enhances communication and collaboration among
interdisciplinary healthcare teams. Nurses can participate in virtual care coordination
meetings, consultations with specialists, and multidisciplinary rounds, facilitating
comprehensive and coordinated care planning. This collaborative approach ensures
that patients receive holistic care that addresses their medical, psychological, and
social needs, regardless of their geographic location.
Furthermore, telehealth expands access to healthcare services for underserved
populations, including rural communities, elderly individuals, and patients with
limited mobility. By eliminating barriers related to travel time, transportation costs,
and geographic distance, telehealth improves equity in healthcare delivery and
enhances healthcare outcomes for vulnerable populations.
As telehealth continues to evolve, nurses play a pivotal role in advocating for
patient-centered telehealth solutions, ensuring that technological advancements align
with patient needs, safety standards, and regulatory requirements. By embracing
telehealth technologies and integrating them into nursing practice, healthcare
professionals can deliver personalized, efficient, and accessible care that meets the
evolving demands of modern healthcare delivery.
According to Gephart and Effken (2013), “The National eHealth Collaborative
Technical Expert Panel recommends fully integrating patient-generated data (e.g.,
home monitoring of daily weights, blood glucose, or blood pressure readings) into the
clinical workflow of healthcare providers” (para. 3). Telehealth technology has
fostered other virtual interfaces, such as system-wide intensive care units in which
intensivists and specially trained nurses monitor critically ill patients in intensive care
units, some of whom may be in rural locations. Sometimes telehealth interfaces allow
patients to interact with a virtual clinician (actually a computer program) that asks
questions, provides social support, and tailors education to identify patient needs
based on the answers to screening questions. These human– technology interfaces
have been remarkably successful; sometimes patients even prefer them to live
clinicians.
Human-technology interfaces encompass a broad spectrum of methods
through which information is conveyed and interactions are facilitated. These
interfaces utilize various modalities such as text, numbers, images, icons, and sound
to present information to users effectively. Whether through visually displayed data,
auditory signals, or even tactile feedback, these interfaces cater to different sensory
preferences and accessibility needs.
In the realm of auditory feedback, alarms and alerts play a crucial role in
notifying users about important information or events. These alarms can range from
simple beeps to complex audio sequences designed to convey urgency or specific
types of information. Visual alerts, on the other hand, use colors, flashing lights, or
changes in display patterns to draw attention to critical updates or notifications.
The methods of interaction with technology are equally diverse. Users can
employ traditional input devices such as keyboards and digital pens for precise control
and data entry. Voice activation systems enable hands-free operation, leveraging
natural language processing to interpret spoken commands and initiate actions. Touch
interfaces, including touchscreens and tactile feedback systems, provide intuitive
ways for users to interact directly with digital content, enhancing engagement and
usability.
Furthermore, advancements in interface design continue to evolve,
incorporating innovations like gesture recognition, augmented reality interfaces, and
haptic feedback systems. Gesture recognition allows users to control devices through
hand movements or body gestures, offering a more immersive and intuitive user
experience. Augmented reality interfaces overlay digital information onto the physical
world, blending virtual and real environments seamlessly.
The integration of haptic feedback enhances user interaction by providing
tactile sensations that simulate the sense of touch, making interfaces more responsive
and engaging. These technologies are particularly beneficial in fields such as
medicine, gaming, education, and industrial applications, where precise control and
feedback are critical.
In summary, human-technology interfaces encompass a rich array of
modalities and interaction methods, each tailored to enhance user experience,
accessibility, and efficiency. By leveraging text, numbers, images, icons, sound, and
various input mechanisms, these interfaces continue to evolve, offering innovative
solutions that redefine how humans interact with and control technology in diverse
contexts.
A small, but growing, number of clinical and educational interfaces rely
heavily on tactile input. For example, many students learn to access an intravenous
site using virtual technology. Other, more sophisticated virtual reality applications
help physicians learn to do endoscopies or practice complex surgical procedures in a
safe environment. Still others allow drug researchers to design new medications by
combining virtual molecules (here, the tactile response is quite different for molecules
that can be joined from those that cannot). In each of these training environments,
accurately depicting tactile sensations is critical. For example, feeling the kind and
amount of pressure required to penetrate the desired tissues, but not others, is essential
to a realistic and effective learning experience.
The growing use of large databases for research has led to the design of novel
human–technology interfaces that help researchers visualize and understand patterns
in the data that generate new knowledge or lead to new questions. Many of these
interfaces now incorporate multidimensional visualizations, in addition to scatter
plots, histograms, or cluster representations (Vincent, Hastings-Tolsma, & Effken,
2010). Some designers, such as Quinn (the founder of the Design Rhythmics
Sonification Research Laboratory at the University of New Hampshire) and Meeker
(2000), use variations in sound to help researchers hear the patterns in large datasets.
In Quinn and Meeker’s (2000) “climate symphony,” different musical instruments,
tones, pitches, and phrases are mapped onto variables, such as the amounts and
relative concentrations of minerals, to help researchers detect patterns in ice core data
covering more than 110,000 years. Climate patterns take centuries to emerge and can
be difficult to detect. The music allows the entire 110,000 years to be condensed into
just a few minutes, making detection of patterns and changes much easier.
The human-technology interface in healthcare is pervasive and manifests in a
multitude of forms, each influencing the quality of care and patient outcomes in
unique ways. While advancements in medical technology have revolutionized
diagnosis, treatment, and patient management, the quality of these interfaces can vary
significantly, presenting both opportunities and challenges.
One significant aspect of healthcare interfaces is their role in information
dissemination and decision-making. Effective interfaces can efficiently present critical
patient data, medical imaging, and diagnostic information to healthcare professionals,
enabling timely and accurate clinical decisions. Conversely, poorly designed
interfaces may lead to misinterpretation of data, delays in treatment, or even errors in
patient care.
In patient monitoring systems, the interface plays a crucial role in displaying
real-time physiological data such as heart rate, blood pressure, and oxygen saturation.
Clear, intuitive interfaces facilitate quick assessment of patient status, allowing
healthcare providers to respond promptly to changes in health conditions. However,
interfaces that are cluttered or difficult to navigate can impede workflow and increase
the risk of oversight or misinterpretation of vital signs.
The integration of electronic health records (EHRs) has been both a boon and
a challenge in healthcare interfaces. EHR systems consolidate patient information
across healthcare settings, promoting continuity of care and facilitating
communication among providers. Well-designed EHR interfaces support efficient
documentation, decision support, and retrieval of patient information. On the other
hand, issues such as cumbersome user interfaces, interoperability challenges between
different systems, and the potential for information overload can hinder usability and
productivity.
Medical imaging interfaces represent another critical area where interface
design impacts diagnostic accuracy and workflow efficiency. Radiologists and other
imaging specialists rely on interfaces that allow for detailed inspection of images
while providing tools for annotation, measurement, and comparison. Clear
visualization and intuitive manipulation of imaging data are essential for accurate
diagnosis and treatment planning. Complex interfaces or inadequate display
capabilities can lead to diagnostic errors or delays in patient care.
Furthermore, the interface between healthcare providers and patients is
increasingly digital, with telemedicine platforms enabling remote consultations and
virtual care delivery. User-friendly interfaces in telehealth applications are essential
for ensuring accessibility, patient engagement, and effective communication between
healthcare providers and patients across different locations. Issues such as
connectivity issues, audiovisual quality, and user interface design can impact the
overall patient experience and satisfaction with telehealth services.
In summary, while the human-technology interface in healthcare holds
tremendous promise for improving patient care and operational efficiency, its quality
is paramount. Designing interfaces that are intuitive, user-friendly, and supportive of
clinical workflows is essential for maximizing the benefits of medical technology
while minimizing risks associated with usability issues or errors. Continued
advancements in interface design, usability testing, and user feedback mechanisms are
crucial for optimizing healthcare interfaces and enhancing their contribution to quality
care delivery.
g. The Human–Technology Interface Problem
In The Human Factor, Vicente (2004) cited the many safety problems in health
care identified by the Institute of Medicine’s (1999) report and noted how the
technology (defined broadly) used often does not fit well with human characteristics.
As a case in point, Vicente described his own studies of nurses’ PCA pump errors.
Nurses made the errors, in large part, because of the complexity of the user interface,
which required as many as 27 steps to program the device. Vicente and his colleagues
developed a PCA in which programming required no more than 12 steps. Nurses who
used it in laboratory experiments made fewer errors, programmed drug delivery faster,
and reported lower cognitive workloads compared to the commercial device. Further
evidence that human–technology interfaces do not work as well as they might is
evident in the following events.
Doyle (2005) reported that when a bar-coding medication system interfered
with their workflow, nurses devised workarounds, such as removing the armband
from the patient and attaching it to the bed, because the bar-code reader failed to
interpret bar codes when the bracelet curved tightly around a small arm. Koppel et al.
(2005) reported that a widely used computer-based provider order entry (CPOE)
system meant to decrease medication errors actually facilitated 22 types of errors
because the information needed to order medications was fragmented across as many
as 20 screens, available medication dosages differed from those the physicians
expected, and allergy alerts were triggered only after an order was written.
Han et al. (2005) reported increased mortality among children admitted to
Children’s Hospital in Pittsburgh after CPOE implementation. Three reasons were
cited for this unexpected outcome. First, CPOE changed the workflow in the
emergency room. Before CPOE, orders were written for critical time-sensitive
treatment based on radio communication with the incoming transport team before the
child arrived. After CPOE implementation, orders could not be written until the
patient arrived and was registered in the system (a policy that was later changed).
Second, entering an order required as many as 10 clicks and took as long as 2
minutes; moreover, computer screens sometimes froze or response time was slow.
Third, when the team changed its workflow to accommodate CPOE, face-toface
contact among team members diminished. Despite the problems with study methods
identified by some of the informatics community, there certainly were serious human–
technology interface problems.
In 2005, a Washington Post article reported that Cedars-Sinai Medical Center
in Los Angeles had shut down a $34 million system after 3 months because of the
medical staff’s rebellion. Reasons for the rebellion included the additional time it took
to complete the structured information forms, failure of the system to recognize
misspellings (as nurses had previously done), and intrusive and interruptive
automated alerts (Connolly, 2005). Even though physicians actually responded
appropriately to the alerts, modifying or canceling 35% of the orders that triggered
them, designers had not found the right balance of helpful-tointerruptive alerts. The
system simply did not fit the clinicians’ workflow.
Human-technology interface problems in healthcare represent a critical area of
concern, influencing patient safety, healthcare quality, and clinical outcomes.
According to Walsh & Beatty (2002), up to 87% of all patient monitoring incidents
can be attributed to issues related to the interface between humans and technology.
Interestingly, these incidents often stem not from faulty technology itself but from
shortcomings in interface design, which can inadvertently contribute to errors made
by healthcare providers.
The complexity and usability of interfaces in medical devices and systems
play a significant role in their effectiveness and user acceptance. Poorly designed
interfaces can lead to confusion, misinterpretation of data, and workflow
inefficiencies, ultimately compromising patient care. For instance, interfaces that
present vital signs or diagnostic information in a cluttered or unintuitive manner may
hinder quick and accurate decision-making by healthcare professionals.
Moreover, the design of human-technology interfaces must consider the
diverse needs of healthcare providers, who may vary in technical expertise,
experience levels, and cognitive abilities. Interfaces that are not tailored to the
cognitive and ergonomic characteristics of users can increase the likelihood of errors,
particularly in high-stress and time-sensitive clinical environments.
Vicente (2004) underscores that while the underlying technology may function
flawlessly, the interface design itself can introduce vulnerabilities. This concept
highlights the importance of human factors engineering in healthcare technology,
emphasizing the need for interfaces that are intuitive, easy to navigate, and supportive
of safe and efficient clinical practices.
Furthermore, the integration of electronic health records (EHRs) provides a
notable example where interface design profoundly impacts usability and patient
safety. Issues such as fragmented user interfaces across different modules, non-
standardized terminology, and cumbersome navigation can impede healthcare
providers' ability to retrieve and interpret patient information accurately. These
challenges underscore the importance of user-centered design principles in developing
EHR systems that enhance rather than hinder clinical workflows.
Addressing interface problems in healthcare technology requires a
multidisciplinary approach that incorporates insights from human factors engineering,
cognitive psychology, usability testing, and stakeholder engagement. Collaborative
efforts among healthcare providers, technology developers, and usability experts are
essential to identify interface design flaws, implement improvements, and evaluate the
impact on patient care and safety.
In conclusion, while advancements in medical technology hold promise for
improving healthcare delivery, the design of human-technology interfaces remains a
critical determinant of their effectiveness and safety. By prioritizing user-centered
design principles and integrating human factors considerations into the development
process, healthcare organizations can mitigate interface-related errors, enhance
usability, and ultimately improve patient outcomes in diverse clinical settings.
Rice and Tahir (2014) reported on two errors that remind us we still have a
long way to go to ensure patient safety: In 2011, a pop-up box on a digital blood
glucose reader was misread and the patient was given too much insulin, sending her
into a diabetic coma; in 2013, a patient did not receive his psychiatric medicine for
almost 3 weeks because the pharmacy’s computer system was set to automatically
discontinue orders for certain drugs, and there was no alert built in to notify the team
providing care to this patient that the drug was suspended. The real issue is that the
healthcare personnel–technology interfaces continue to cause these adverse events
and near-misses. It is important to remember that it is not only a technology or human
interface issue.
The introduction or modification of technology in healthcare settings often
brings about challenges related to interface usability, user training, testing
methodologies, and integration into care delivery processes. These aspects are crucial
in ensuring that technological advancements enhance rather than hinder patient care
and safety.
When new technology is introduced, rigorous testing protocols are essential to
identify potential interface issues, functionality gaps, and interoperability concerns.
Testing methodologies should encompass usability testing, which evaluates how
easily and effectively healthcare providers can interact with the technology in
simulated or real-world scenarios. Human factors engineering principles guide these
tests to ensure that interfaces are intuitive, responsive, and conducive to safe clinical
practices.
Furthermore, the preparation of human users—such as healthcare providers,
nurses, and support staff—is paramount to successful technology adoption.
Comprehensive training programs should be implemented to familiarize users with
the technology's features, functionalities, and interface navigation. Training sessions
should address diverse learning styles and proficiency levels to promote confidence
and competence among users. Additionally, ongoing education and support are
necessary to keep users updated on system upgrades, new features, and best practices
in technology utilization.
Integration of technology into the care delivery process requires careful
planning and coordination across multidisciplinary teams. Healthcare organizations
must consider workflow implications, care coordination dynamics, and patient
engagement strategies when implementing new technologies. Effective integration
involves aligning technological capabilities with clinical workflows to optimize
efficiency, minimize disruptions, and promote seamless transitions between care
settings.
Moreover, assessing the impact of technology on patient outcomes and
healthcare delivery metrics is essential for continuous improvement. Data analytics
and feedback mechanisms can provide insights into how well technology supports
clinical decision-making, improves care coordination, enhances patient safety, and
reduces healthcare costs. Continuous monitoring and evaluation allow healthcare
organizations to refine interface design, adjust training protocols, and address
workflow challenges proactively.
Additionally, stakeholder engagement—including input from frontline
healthcare providers, patients, caregivers, and technology developers—is critical
throughout the technology implementation process. Collaborative partnerships foster
a shared understanding of user needs, preferences, and challenges, leading to the
development of more responsive and user-centric solutions.
In conclusion, the successful integration of technology into healthcare requires
a holistic approach that encompasses rigorous testing, comprehensive user training,
thoughtful integration into care processes, and ongoing evaluation. By prioritizing
these aspects, healthcare organizations can mitigate challenges associated with new
technology adoption, optimize clinical workflows, and ultimately improve patient
outcomes in diverse care settings.
h. Securing Network Information
Typically, a healthcare organization has computers linked together to facilitate
communication and operations within and outside the facility. This is commonly
referred to as a network. The linking of computers together and to the outside world
creates the possibility of a breach of network security and exposes the information to
unauthorized use. With the advent of smart devices, managing all of these risks has
become a nightmare for some institutions’ security processes. In the past, stationary
devices or computers resided within healthcare facilities. Today, smart devices travel
in and out of healthcare organizations with patients, family members, and other
visitors, as well as employees—both staff and healthcare providers alike.
Sullivan's observation regarding wireless medical devices (MDs) highlights a
growing concern in healthcare regarding cybersecurity and the integration of
technology into medical practices. As the healthcare industry increasingly adopts
wireless MDs equipped with commercial operating systems and internet connectivity,
the potential security risks escalate.
The evolution of wireless MDs has brought significant benefits, including
improved patient monitoring, enhanced data accessibility for healthcare providers,
and greater patient convenience. However, these advancements also introduce
vulnerabilities that malicious actors could exploit. Medical devices connected to the
internet can be targets for cyberattacks, ranging from data breaches to unauthorized
access and manipulation of device functions.
One of the primary security challenges highlighted by Sullivan is the
susceptibility of commercial operating systems used in MDs to cyber threats. Unlike
specialized, hardened systems designed for medical devices, commercial operating
systems such as Windows or Linux may have broader attack surfaces and may not
prioritize the stringent security measures required for healthcare environments. This
vulnerability underscores the importance of robust cybersecurity protocols and
continuous monitoring to protect patient data and ensure the integrity of medical
device operations.
Moreover, the interconnected nature of wireless MDs within healthcare
networks increases the complexity of security management. Each connected device
represents a potential entry point for cyber threats, necessitating comprehensive
network segmentation, encryption protocols, and access controls to safeguard
sensitive information and prevent unauthorized access.
Furthermore, the rapid pace of technological innovation in healthcare
introduces challenges in maintaining the security posture of wireless MDs over their
lifecycle. Updates and patches are essential to address newly discovered
vulnerabilities and mitigate emerging cyber threats. However, the implementation of
updates in healthcare settings must balance security requirements with the need to
minimize disruptions to patient care and clinical workflows.
Another critical aspect highlighted by Sullivan is the need for healthcare
organizations to prioritize cybersecurity awareness and training among staff.
Healthcare professionals, from clinicians to IT personnel, play pivotal roles in
maintaining the security of wireless MDs by adhering to best practices, recognizing
phishing attempts, and promptly reporting suspicious activities.
Looking ahead, the healthcare industry faces the dual challenge of leveraging
the benefits of wireless MDs while effectively managing cybersecurity risks.
Collaborative efforts among healthcare providers, device manufacturers, cybersecurity
experts, and regulatory bodies are essential to develop and implement robust security
standards, guidelines, and frameworks that safeguard patient information and uphold
the integrity of medical device operations.
In conclusion, while wireless medical devices offer transformative potential in
healthcare delivery, Sullivan's cautionary note reminds us of the critical importance of
addressing cybersecurity risks. By proactively addressing vulnerabilities, adopting
stringent security measures, and fostering a culture of cybersecurity awareness,
healthcare organizations can mitigate risks and ensure that wireless MDs contribute
safely and effectively to improved patient care outcomes.
The three main areas of secure network information are (1) confidentiality, (2)
availability, and (3) integrity. An organization must follow a well-defined policy to
ensure that private health information remains appropriately confidential. The
confidentiality policy should clearly define which data are confidential and how those
data should be handled. Employees also need to understand the procedures for
releasing confidential information outside the organization or to others within the
organization and know which procedures to follow if confidential information is
accidentally or intentionally released without authorization. In addition, the
organization’s confidentiality policy should contain consideration for elements as
basic as the placement of monitors so that information cannot be read by passersby.
Shoulder surfing, or watching over someone’s back as that person is working, is still a
major way that confidentiality is compromised.
Availability refers to network information being accessible when needed. This
area of the policy tends to be much more technical in nature. An accessibility policy
covers issues associated with protecting the key hardware elements of the computer
network and the procedures to follow in case of a major electric outage or Internet
outage. Food and drinks spilled onto keyboards of computer units, dropping or jarring
hardware, and electrical surges or static charges are all examples of ways that the
hardware elements of a computer network may be damaged.
In the event of an electrical outage or a weather-related disaster, ensuring
continuity of care delivery and safeguarding patient data becomes paramount for
healthcare organizations. Network administrators play a critical role in planning,
implementing, and maintaining robust strategies to mitigate disruptions and ensure
seamless operations during such challenging circumstances.
Effective disaster preparedness begins with comprehensive data backup,
storage, and retrieval protocols. Network administrators must establish regular backup
schedules to ensure that critical patient records, medical images, treatment plans, and
administrative data are securely duplicated and stored in geographically diverse
locations. This redundancy not only protects against data loss due to power outages or
natural disasters but also supports timely data recovery and restoration in emergency
situations.
Modern backup solutions often leverage cloud computing technologies,
providing scalable and resilient storage options that are accessible from multiple
locations. Cloud-based backups enable healthcare organizations to maintain continuity
of operations even if primary data centers are affected by local disruptions.
Additionally, encrypted backups help safeguard patient confidentiality and comply
with regulatory requirements governing healthcare data protection.
Network administrators must develop clear procedures and contingency plans
to ensure care delivery continuity in the face of disruptions. This includes identifying
alternative communication channels, such as mobile devices or satellite connections,
to facilitate real-time collaboration among healthcare providers during emergencies.
Protocols should outline roles and responsibilities for staff members, ensuring that
they are prepared to adapt to changing circumstances and prioritize patient care.
Moreover, healthcare organizations can implement redundant power systems,
such as uninterruptible power supplies (UPS) and backup generators, to maintain
essential operations during electrical outages. Regular maintenance and testing of
these systems are essential to verify their reliability and readiness to support critical
infrastructure, including medical equipment and communication networks.
Telehealth technologies and remote monitoring solutions play a pivotal role in
ensuring continuous care delivery during emergencies. Network administrators can
integrate telehealth platforms that enable virtual consultations, remote patient
monitoring, and telemedicine services. These technologies enable healthcare
providers to assess patient conditions, deliver timely interventions, and coordinate
care remotely, reducing the need for in-person visits during disruptive events.
Effective communication is key to managing emergencies effectively.
Network administrators should establish communication protocols that enable
seamless information sharing among healthcare teams, emergency responders, and
stakeholders. This includes leveraging communication tools such as secure messaging
platforms, video conferencing systems, and alert notification systems to disseminate
critical updates and instructions in real-time.
Regular training and preparedness exercises are essential for ensuring that
healthcare staff are familiar with emergency protocols and capable of executing them
under stress. Simulation drills simulate scenarios such as power outages or natural
disasters, allowing teams to practice response procedures, validate communication
channels, and identify areas for improvement in care delivery and data management.
Compliance with regulatory requirements, such as HIPAA (Health Insurance
Portability and Accountability Act) in the United States, ensures that patient data
remains protected and accessible during emergencies. Network administrators must
adhere to data security standards, conduct risk assessments, and implement controls to
mitigate cybersecurity risks that may arise during disruptive events.
In conclusion, proactive planning, robust infrastructure, clear communication,
and ongoing training are essential components of effective disaster preparedness for
healthcare organizations. By prioritizing data backup, storage, and retrieval strategies,
implementing alternative care delivery methods, and leveraging technology-enabled
solutions, network administrators can safeguard patient care continuity and mitigate
the impact of electrical outages or weather-related disasters on healthcare operations.
Another way organizations protect the availability of their networks is to
institute an acceptable use policy. Elements covered in such policy could include
which types of activities are acceptable on the corporate network. For example, are
employees permitted to download music at work? Restricting downloads is a very
common way for organizations to prevent viruses and other malicious code from
entering their networks. The policy should also clearly define which activities are not
acceptable and identify the consequences for violations.
The last area of information security is integrity. Employees need to have
confidence that the information they are reading is true. To accomplish this,
organizations need clear policies to clarify how data are actually inputted, determine
who has the authorization to change such data, and track how and when data are
changed. All three of these areas use authorization and authentication to enforce the
corporate policies. Access to networks can easily be grouped into areas of
authorization (e.g., users can be grouped by job title). For example, anyone with the
job title of “floor supervisor” might be authorized to change the hours worked by an
employee, whereas an employee with the title of “patient care assistant” cannot make
such changes.
i. Workflow Analysis Purpose
According to the American Association for Justice (2016), Research has
confirmed that 440,000 people die every year because of preventable medical errors.
That is equivalent to almost the entire population of Atlanta, Georgia dying from a
medical error each year. Preventable medical errors are the third leading cause of
death in the United States and cost our country tens of billions of dollars a year.
Not only is there an impact on patients and their families from these errors, but
there is also a significant financial impact on healthcare organizations. Clearly, we
must minimize these errors, and one of the most important tools for this purpose is the
use of electronic health records and information systems to provide point-of-care
decision support and automation. The key point is that most of these errors are
preventable and we must find ways to prevent them.
Technology can provide a mechanism to improve care delivery and create a
safer patient environment, provided it is implemented appropriately and considers the
surrounding workflow. In an important article by Campbell, Guappone, Sittig,
Dykstra, and Ash (2009), the authors suggested that technology implemented without
consideration of workflow can provide greater patient safety concerns than no
technology at all. Computerized provider order entry (CPOE) causes us to focus more
specifically on workflow considerations. These workflow implications are referred to
as the unintended consequences of CPOE implementation; they are just some of the
effects of poorly implemented technology. The Healthcare Information Management
Systems Society (HIMSS, 2010) ME-PI Toolkit addressed workflow redesign and
considered why it is so critical to successful technology implementations. Thompson,
Kell, Shetty, and Banerjee (2016) stated “By partnering clinicians with informaticists
we strove to leverage the power of the electronic medical record (EMR) to reduce
heart failure readmissions and improve patient transitions back to the community”
They concluded that “Partnering with clinical informatics enabled the
multidisciplinary team to leverage the power of the EMR in supporting and tracking
new clinical workflows that impact patient outcomes” (p. 380). This multidisciplinary
team believed that their success could reshape how healthcare providers facilitate
patient discharge and the transition home. Leveraging the multidisciplinary team and
EMR could provide a model for patient-centered and cost-effective care that could
extend beyond their patients with heart failure.
Technology is recognized to have a potentially positive effect on patient
outcomes. Nevertheless, even with the promise of improving how care is delivered,
adoption of technology has been slow. The cost of technology solutions such as
CPOE, barcode medication administration (BCMA), and electronic health records
(EHRs) remain staggeringly high. The cost of technology, coupled with the lengthy
timelines required to develop and implement such technology, has put this endeavor
out of reach for many healthcare organizations. In addition, upgrades or enhancements
to the technology are often necessary either mid- implementation or shortly after a
launch, leaving little time to focus efforts on the optimization of the technology within
the current workflow. Furthermore, the existence of technology does not in itself
guarantee that it will be used in a manner that promotes better outcomes for patients.
For an organization that seeks to meet these measures, the data to support
these measures must be gathered and reported on electronically—necessitating the use
of technology in all patient care areas. The successful implementation of the
measurement development plan “depends on a successful partnership with patients,
frontline clinicians, and professional organizations and collaboration with other
diverse stakeholders to develop measures that are meaningful to patients and
clinicians and can be used across payers and health care settings” (CMS, 2016c, p.
64). Many of the quality reporting measures rely on nursing and medical
documentation. Most healthcare personnel already use EHRs, but MACRA measures
will push healthcare organizations to reexamine the use of clinical technologies within
their organization and approach implementations in a new way.
Not only is there a potential for patient safety and quality issues to arise from
technology implementations that do not address workflow, but a financial impact to
the organization is possible as well. All organizations, regardless of their industry,
must operate efficiently to maintain profits and continue to provide services to their
customers. For hospitals, which normally have significantly smaller profit margins
than other organizations, the need to maintain efficient and effective care is essential
for survival. Given that hospital profit margins are diminishing, never has there been a
more crucial time to examine the costs of errors and poorly designed workflows and
the financial burden they present to an organization than now. Moreover, what are the
costs to an organization that fails to address the integration of technology? This is an
area where few supporting data exist to substantiate the claim that technology without
workflow considerations can, in fact, impact the bottom line.
Today, many healthcare organizations are experiencing the effects of poorly
implemented clinical technology solutions. These effects may be manifested in the
form of redundant documentation, non-value-added steps, and additional time spent at
the computer rather than in direct care delivery. For example, Gugerty et al. (2007)
studied the challenges and opportunities in nursing documentation and determined
that it was possible to decrease the time a nurse spends documenting per shift by 25%.
Technology ought not to be implemented for the sake of automation unless it
promises to deliver gains in patient outcomes and proper workflow. In fact, the cost to
organizations for duplicate/redundant documentation by nursing can range from
$6,500 to $13,000 per nurse, per year.
Stokowski's findings shed light on significant challenges within healthcare
systems that impact nursing workflows and patient care efficiency. The issues
identified, including system slowness, freezing, data loss, and delays in real-time data
integration with electronic health records (EHRs), underscore the complexities and
consequences of suboptimal technology integration in clinical settings.
The performance of healthcare information systems directly affects nursing
productivity and patient care quality. Slow response times and system freezes can
disrupt workflow continuity, leading to frustration among nurses and potential delays
in patient assessments, medication administration, and care documentation.
Addressing system performance issues requires continuous monitoring, infrastructure
optimization, and software updates to ensure responsiveness and reliability.
The seamless integration of data from monitoring devices and screening tools
into EHRs is crucial for providing timely and accurate patient information to
healthcare providers. Stokowski's findings highlight challenges where systems fail to
update EHRs in real-time, forcing nurses to spend additional time manually inputting
data or verifying information. This inefficiency not only detracts from direct patient
care but also introduces the risk of data discrepancies and delayed clinical decision-
making.
The increased reliance on technology in healthcare necessitates that nursing
workflows adapt to accommodate electronic documentation requirements. Nurses
spend significant time navigating EHR interfaces, inputting data, and retrieving
patient information, detracting from face-to-face patient interactions and holistic care
delivery. Streamlining documentation processes, improving interface usability, and
providing adequate training are essential to minimizing the administrative burden on
nurses and optimizing their time at the bedside.
Ensuring a positive user experience is essential for optimizing the adoption
and effectiveness of healthcare information systems. User-centered design principles
should guide the development of interfaces that are intuitive, user-friendly, and
tailored to the unique needs of healthcare providers. Comprehensive training
programs are equally vital to familiarize nurses with system functionalities, shortcuts,
and troubleshooting techniques, empowering them to navigate technology efficiently
and focus on patient-centered care.
The integration of diverse technologies within healthcare ecosystems,
including EHRs, medical devices, and communication platforms, presents
interoperability challenges. Standardizing data formats, improving interface
compatibility, and fostering collaboration between technology vendors are critical
steps toward achieving seamless information exchange and enhancing care
coordination across multidisciplinary teams.
Continuous feedback loops and stakeholder engagement are essential for
identifying system inefficiencies, prioritizing enhancements, and implementing
sustainable improvements. Collaborative efforts between IT professionals, healthcare
administrators, clinicians, and end-users foster a culture of innovation and
responsiveness to evolving clinical needs and technological advancements.
Ensuring regulatory compliance, such as adhering to HIPAA regulations for
patient data privacy and security, remains paramount in healthcare technology
implementations. Robust cybersecurity measures, data encryption protocols, and
access controls are necessary to safeguard sensitive information and mitigate the risk
of unauthorized access or data breaches.
In conclusion, addressing the challenges identified by Stokowski requires a
holistic approach that encompasses technological optimization, workflow redesign,
user empowerment through training, and collaboration across healthcare stakeholders.
By prioritizing system performance, data integrity, user experience, and regulatory
compliance, healthcare organizations can enhance nursing efficiency, improve patient
care outcomes, and foster a supportive environment for innovation in clinical practice.
Examining the workflow surrounding the use of technology enables better use
of the technology and more efficient work. It also promotes safer patient care delivery.
The need to focus on workflow and technology is attracting increasing recognition,
although there remains a dearth of literature that addresses the importance of this area.
As more organizations work to achieve a level of technology adoption that will enable
them to meet MACRA measures and receive financial payments, we will likely see
more attention paid to the area of workflow design and, therefore, a greater body of
research and evidence.
