THE ROLE OF THE EXECUTIVE

IN INFORMATION TECHNOLOGY
DECISION MAKING
Ray L. Simpson
 OBJECTIVES
• Discuss why the technology lifecycle virtually ensures perpetual healthcare information
technology (HIT) decision-making in healthcare delivery environments.
• Describe the need for executive nurses to commit to lifelong learning if they are to
participate and actively lead HIT decision-making.
• Identify the two most important HIT processes that demand nurse executive involvement.
• Discuss where to turn for help in developing and maintaining a nursing-centric, deep HIT
competency.
• Describe the value that only nurse executives, acting as the all-important "voice of the
patient," bring to HIT decision-making.
 INTRODUCTION
• To productively contribute and, ultimately, drive technology decisions, nurse executives
need to be constantly updating and advancing their hospital information technology (HIT)
knowledge.

• This knowledge needs to go beyond baseline functionality-level information of nursing

and clinical information systems, which describes systems can accomplish, to more a
complex under ending of enterprise-wide integration, data and process mapping, and
business analytics.

• Commanding a deep well of HIT expertise helps nurse executives understand the delicate
interplay of nursing inside healthcare organization
 FLAWED THINKING
• Most nurse executives view technology-related decision making as an episodic responsibility that takes
place once every seven to 10 years, the timeframe when major HIT systems are replaced.

• In the lived experience, technology decision-making happens with regularity throughout the year-every
year.

• From an executive nurse perspective, the complexity of HIT, coupled with the speed of innovation and the
rapid adoption of emerging technologies, requires that theoretical and applied knowledge of HIT be up-to-
date at all times.

• As the largest "user group" in most healthcare organizations, nursing feels the impact of technology
decisions faster and more often than other user populations in the healthcare organization.
 TECHNOLOGY’S LIFE CYCLE
• The lifecycle of every technology investment spans six distinct phases, from planning to procurement to
deployment to management to support and disposition, only to cycle back to planning.
 TECHNOLOGY’S LIFE CYCLE
• The lifecycle of every technology investment spans six distinct phases, from planning to
procurement to deployment to management to support and disposition, only to cycle
back to planning.

• Overlaying this lifecycle with an ever-present technology obsolescence complicates

technology-related decision making further. Three key types of obsolescence exist:
 Technology providers' architecture, product, and integration plans
 Third parties' priority shifts
 Regulators' unexpected recalls
 MULTI-LAYERED DECISION-
MAKING
• Nursing-centric technology decisions emerge from a context that includes cultural,
economic, social, and physical requirements.

• Adding an outcome orientation to those decisions layer impacts the cost, quality, safety,
and satisfaction.

• Nursing Informatics staff then views technologies under consideration from the dual
perspectives of content structure and information flow.

• The Informatics Research Organizing model (Effken, 2003) captures the intrinsic
complexity of the healthcare-centered technology decision making process.
 NURSE INFORMACIST ROLE
• Technologies optimized for the nursing process organize and prioritize patient care data
against a complex backdrop of quality and patient safety.

• Nurse executives' responsibility to evaluate, select, and deploy these advanced

technologies requires one of two things:

(1) either a deep personal and nursing-centric knowledge of technology or

(2) access to that knowledge, which is resident in a technology expert.

• Considering the organizational and interdisciplinary demands on nurse executives, a

direct reporting structure to the technology expert offers the most efficient and effective
pathway to this highly specialized knowledge.
TWO KEY AREA OF EXPERTISE
• Nurse executives and NIs involved in technology decision making need to leverage two
specific type of IT expert when they evaluate, select, and implement clinical information
systems: process mapping and workflow design.
• The success of every HIT implementation hinges on having a clear understanding of
process mapping and workflow design, as well as the ability to chart these activities in a
format understandable by computers.
• Vendor-resident engineers lack the site-specific and nursing practice-specific knowledge
required to add the context of the lived experience to the workflow creation process.
• From a nursing perspective, leaving this critical foundational work to engineers and
technologists who lack the hands-on experience of delivering patient care at the bed side
pure folly.
 STANDARDIZATION LACKING
• The importance of process mapping and workflow design in the binary world of
computers where options are limited to yes" or "no" collides head-on with the lack of
standardization in nursing process, procedure, and operation.
• Only the nurse executive or an NI working in concert with the nurse executive can
design and implement overarching nursing workflows that reflect the organization's
nursing process.
• While some aspects of patient care remain resistant to standardization, the vast majority
of these processes can be architected into workflows in much the same way that
engineering has codified its processes and procedures.
• The criticality of these two elements and their founder national importance makes a
working knowledge of process mapping and workflow design knowledge essential to
nurse executives' evaluation and selection of clinical information systems (Simpson,
2012).
 NURSE EXECUTIVE
MARGINALIZED
• Nurse executives point to two specific ways they are marginalized in the evaluation and selection
of clinical information systems, according to recent research (Simpson, 2012).
• Most often, the nurse executives found their review responsibilities limited to the functional
level; that is, looking at the systems' features, rather than their ability to advance nursing
practice.
• Second, nurse executives explained that CMO-led physician contingents regularly dominated IT
decision-making, relegating nurse executives to a "specifier/recommender" role.
• As a result, nurse executives found their opportunities to advocate effectively for technology
needed to support nursing practice during the evaluation and selection of clinical information
systems to be limited.
• In addition to being marginalized during the technology evaluation and selection process, nurse
executives found they lacked technology-related competency despite the advanced degrees.
NEW FRONTIER: SOCIAL MEDIA
•Although the informant nurse executives demonstrated knowledge of technology-fueled
innovation in nursing practice, two substantial gaps exist between their knowledge and
AONE's stated competency:
Nurse executives' awareness of societal and technological trends, issues, and new
developments as they relate to the clinical practice of nursing.
Nurse executives' awareness of legal and ethical issues related to client data,
information, and confidentiality.
• It is interesting to note that nurses' use of social media lies at the intersection of these
two gaps.
• In the lived experience, for example, nurses routinely Social media to communicate
nurse-to-nurse, nurse-to patient and nurse-to-patient family, nurse-to-physician, and e-
to-interdisciplinary team (Black, Light, Paradise, & Thompson, 2013).
 QUICKENING PACE OF
TECHNOLOGY ADOPTION
• This inability to maintain current knowledge, of both technical capabilities and the
application of those capabilities to the healthcare organization, presents a particularly
troubling scenario when viewed against an emerging trend: the swift pace of technology
adoption.
• Consider the pace of "no phone-to-smart phone" adoption.
• It took 39 years for American's first landline phones to make their way into 40% of
American households and an additional 15 years for the telephone to become prevalent.
• That is a total of 54 years. Yet, it took only 10 years for the smart phone to reach the
40% penetration rate in 2012 (DeGusta, 2013).
• That is why the smart phone has been touted as the most rapidly adopted technology in
recorded history
 SUMMARY
• Nurse executives at healthcare organizations of all sizes need help if they are to
acquire and maintain current knowledge of HIT.
• Building and maintaining this deep technology competency across the country's
ranks of nurse executives will ensure that the “voice of the patient" is heard
when these all-important technology decisions are made.
• Failing to answer nursing's needs with advanced technologies and systems
tailored to their specific clinical environments imperils the quality of patient care
as it risks the longevity of nurses and the healthcare organization as well.