Design Considerations and Workarounds
NURS 6401, Informatics in Nursing and Healthcare
October 3, 2018
Design Considerations and Workarounds
Health Information Technology (HIT) has been changing the way healthcare professional practice and has helped to improve patient safety and clinical outcomes. Examples of HIT include Electronic Medical Records (EHR), Personal Health Records (PHRs), Computerized Prescriber Order Entry (CPOE), Barcode-Assisted Medication Administration (BCMA), etc. Most healthcare organizations in the U.S. still use paper-based systems, and these systems are subject to errors in transcription, storage, and health information retrieval (Lawler et al., 2011). The safety of hospitals has been a concern for consumers following the number of reports of medical mistakes, which have resulted in harm and death (Saba & McCormick, 2017). The HITECH Act has been used to promote the meaningful use of health information technology to improve patient safety (Saba & McCormick, 2017). Using information technology can improve healthcare delivery, reduce errors, and cost. To effectively design, implement, and use HIT, the hardware, software, and human factor must be put into consideration. The purpose of this paper is to discuss how hardware, software, and human factors can impact the implementation of an informatics system.
Design Considerations for Hardware
Selecting the right hardware for a system often depends on its design, application, and software requirements (Saba & McCormick, 2017). It is often desirable for new systems to have the ability to operate on multiple hardware platforms. A significant consideration for hardware design is the adaptability of the hardware, which can have a high impact on the successful implementation of new systems. Technology should be able to adapt to available resources and constraints. For example, users should be able to use and switch between multiple devices like laptops, desktops, or mobile phone while still participating in computational activities. For this adaptation to be possible, applications need to adapt to different CPU capabilities, presence or absence of a hard disk, and bandwidth of communication channels.
Another hardware consideration is the type of device to be used. Devices like mobile PCs, computer on the wheel (COW), handheld devices, laptops, and desktops are used to access patients information. Selection of a minicomputer, mainframe computer or microcomputer depends on technical conditions (Saba & McCormick, 2017). It is also essential to choose hardware that would be compatible with the available software. The type of device chosen should have the ability to compliment workflow processes and improve clinical outcomes.
Informaticist should pay close attention to these considerations because they can either have a positive or negative impact on quality of care and patient safety. Imagine not being able to use multiple devices to view patient information, and patient care can be interrupted or slow. Also, health care providers will find it challenging to coordinate care from various locations. The type of devices used in patient care can also pose a safety issue. For example, the Barcode technology is used to improve safe administration of medications. Chances of error are high without the use of barcode technology, and patient safety will be in jeopardy should an error occur.
Design Considerations for Software
Application software consists of operational requirements for new systems, and the project manager ensures that the best technology platform is available for the software (Saba & McCormick, 2017). Software needs routine maintenance and upgrades to keep its functionality. A significant consideration for software design is the interoperability of systems. Exchange of information is vital in healthcare and systems should be able to interface with other IT systems (Ross et al., 2016). Different systems use various interface and coding standards; therefore, software applications need to support different standards (Armour & Thizy, n.d.). A requirement of meaningful use consists of the ability to share data electronically with various agencies and patients (Saba & McCormick, 2017). Some healthcare organization uses Health Information Exchanges (HIEs), which send patients’ data through interfaces outside health care systems domains (Saba ; McCormick, 2017).
Another software consideration is usability. Software should be tailored for different end-users, and also less complicated to use. The new system should be designed for health providers based on specialty and not be a one size fits all model (Armour ; Thizy, n.d.). For example, software used in oncology is different from that used in radiology, and it would be challenging for a radiology provider to use oncology application.
It is crucial for informaticist to put these considerations in mind when designing a new system. These considerations enable informaticist to evaluate the new technology to be implemented carefully. Potential dangers interoperability pose to patient safety is the delay in care and prompt decision-making. Providers waiting to get patient data from other agencies in an emergency situation can cause a delay in treatment and could be life-threatening for the patient. Regarding usability, providers do not like a software application that is difficult to navigate and takes too much time. Healthcare providers are always pressed for time because their actions mostly affect the quality of patient care. The easier it is to navigate software, the faster it is to make health care decisions and improve clinical outcomes.
Design Consideration for Human Factors
Human factors are a discipline that evaluates the relationships between technology and humans (Saba ; McCormick). Human factors should be considered during the design of a new system because they play an important role in its successful implementation. A major human factor consideration is the users of the new technology. The intended user of the new system should be able to use it without errors that could compromise the quality of care. Another consideration is the device use environment. Technology users include health care providers, patients, and family members. The ability of a user to operate the new technology depends on different characteristics, which include literacy and language skills, knowledge and experience with the device, ability to learn and adapt to a new device, and willingness to learn new technology (FDA, 2017).
Failure to consider the characteristics above can potentially cause dangers to the patient. Users need to be in their right state of mind to be able to operate new technology without errors. Also, the environment in which device is to be used should be free of clutters to make it easier for users to maneuver and be free of distractions so as not to confuse or overwhelm users (FDA, 2017). Frontline users opinion should be considered during the design of new systems because they can promote quality of care and patient safety.
Benefits and Consequences of Workarounds
According to Debono et al. (2013), clinicians use workarounds to respond to the complexity of care within a system that demands standardization. Nurses are said to be the major users of workarounds and find various ways to work around the system to obtain medications (Saba ; McCormick, 2017). One benefit of workaround is the ability of clinicians to be able to override certain medications in emergency situations. Workarounds benefit clinicians regarding meeting their needs and work efficiencies, but they may also weaken the reliability and system measures that have been put in place to improve patient safety and quality of care (Lawler et al., 2011). A workaround is more common with barcode technology. Clinicians sometimes chose not to scan patients or medication and enter information manually, which can result in errors and jeopardize patients’ safety. Nurses acknowledge workaround as essential circumventions to deliver timely and customized patient-centered care in highly complex systems (Debono et al., 2013).
Selecting Informatics Technology
Purchasing a system that mitigates opportunity for workarounds should be considered when choosing an informatics technology because workarounds are sometimes necessary. Pharmacies are responsible for screening and verifying every medication that is ordered for a patient before making it available for dispense. This process often takes time and can cause a delay in treatment. Having a system that allows clinicians to override medication would be useful when pharmacy take time to verify. Also, a workaround would be beneficial in an emergency situation that could be life threatening for patients. One thing that could be done to prevent errors due to workarounds is for the system to allow dual signoff for every override. Clinicians are overwhelmed by certain situations that they tend to make mistakes that pose a risk to patient safety and quality of care.
Designing a new information system can be a challenge for informaticist but putting hardware, software, and human factors into consideration can help with the successful implementation of such a system. The new system should be designed in a way that it promotes patients’ safety and quality of care. Workaround poses a possibility of errors in healthcare but it is often necessary and can help promote timely patient care.
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U. S. Food and Drug Administration. (2017). Human factor considerations: Human factor engineering. Retrieved from https://www.fda.gov/medicaldevices/deviceregulationandguidance/humanfactors/ucm124829.htm
Design Considerations and Workarounds