SYSTEM LIFE

CYCLE: A
FRAMEWORK
OBJECTIVES
 Describe a methodology and checklist for the phases of a system implementation life cycle.
 Describe barriers and critical success factors related to implementation.
 Describe the Nursing Informaticist role in a clinical system’s implementation life cycle.
 Discuss the heightened impact of regulatory and financial requirements on the Electronic
Health Record (EHR).
OVERVIEW
 the concepts of end-user perceptions determining project success in
conjunction with streamlining clinician workflow layered clinical
systems projects with additional success criteria
 In the past 5 years, the focus for clinical systems implementations
has been on systems improving patient safety through evidenced-
based medicine while meeting the federal requirements set forth in
the Health Information and Technology for Economic and Clinical
Health
SYSTEM LIFE CYCLE (SLC)
tasks multiple disciplines must accomplish to
produce a technically sound, regulatory
compliant and user friendly EHR supporting
safe, effective and efficient patient care
delivery.
ELECTRONIC HEALTH
RECORD
 longitudinal electronic record of patient health information
generated by one or more encounters in any care delivery setting.
 patient demographics, progress notes, problems, medications, vital
signs, past medical history, immunizations, laboratory data, and
radiology reports
 automates and streamlines the clinician’s workflow
a. Has the ability to generate a complete record of a clinical
patient encounter
b. As well as support other care-related activities directly or
indirectly via interface
c. ability to understand and coordinate the work of multiple
disciplines and departments
a. The components of an EHR integrate data in a
coordinated fashion to provide an organization’s
administration and clinicians demographic, financial, and
clinical
information
b. The SLC provides a framework to attain a successful
implementation
SYSTEM LIFE CYCLE
COMPONENTS
a. Planning
b. Analysis
c. Design/Develop/Customize
d. Implement/Evaluate/Maintain/Support
SLC PHASES USE A PROBLEM-
SOLVING, SCIENTIFIC
APPROACH
a. observation and understanding of the operations of the current
systems or processes, sometimes referred to as the “Current State”
b. in-depth assessment and definition of the new system’s
requirements; defining the “Future State”
c. Designing, developing, and customizing a plan to meet
requirements are addressed in the third phase
d. implementing, evaluating, supporting and ongoing maintenance,
assures the system is sustainable after implementation
THE KEY DOCUMENTS
CREATED IN THE PLANNING
PHASE ARE:
• Project Governance Structure
• Gap Analysis
• Feasibility Study
• Project Scope Document
• Development of a high-level workplan and resource
requirements
PLANNING PHASE
 Governance structure and project staff  Scope
 Steering Committee  Timeline
 Project team  Recommendations
 Departmental teams  Documentation and negotiation of a project
scope document
 Develop project scope
 Resource planning
 Definition of the project’s purpose
 Feasibility study
 Statement of the Objective
 Environmental assessment
KEY DOCUMENTS CREATED
IN THIS PHASE ARE:
 Gap Analysis
 Technical requirements for hardware, software, networks
 Functional Design Document
 System Proposal Document
ANALYSIS PHASE
 Data collection
 Gap analysis
 Technical analysis
 Determination of information needs
 Workflow document
 Functional design document
 Data analysis
 Data review
 Benefits identification
 System proposal development
THERE ARE MULTIPLE
PROJECT DOCUMENTS
CREATED IN THIS PHASE
(1) Gap analysis
(2) Functional specifications
(3) Technical specifications
(4) Implementation Workplan containing plans specific to
 i. Hardware & Peripheral Devices
 ii. Interfaces
 iii. Testing
 iv. End User Training
 v. Cut Over Plan
 vi. Go Live Plan

(5) Post Live Evaluation Reports

SYSTEM DESIGN,
DEVELOPMENT, AND
CUSTOMIZATION PHASE
 System design  Development
 Functional specifications  System selection
 Technical specifications  Request for Proposal (RFP)/Request for
Information (RFI)
 Hardware
 Communications plan
 Peripheral Device Plan
 Policies and procedures
 Networks
 Workflow, dictionaries, and profiles
 Application software
 Testing
 Interface applications
 End-user training
 Legacy systems data conversions
IMPLEMENT, EVALUATE,
MAINTAIN, AND SUPPORT
PHASE
 System documentation
 Implementation—Go Live
 Evaluation Post-Live
 Daily support operations
SYSTEM AND
FUNCTIONAL
TESTING
OVERVIEW
System and functional testing are critical
components of the system life cycle.
system life cycle phase usually drives how testing
activities are organized
TESTING MODELS AND
METHODOLOGIES
The Waterfall
model
Agile software
development
Scrum
TESTING STRATEGY AND
PROCESS
Project definition and scope, feasibility assessments,
functional requirements, technical specifications,
required interfaces, data flows, workflows and
planned process redesign, and other outputs of the
planning and analysis phases become the inputs to
the testing plan
SYSTEM ELEMENTS TO BE
TESTED
a. Software functions or components
b. Software features
c. Interfaces
d. Links
e. Devices
f. Reports
g. Screens
h. User security and access
TESTIN
G
TYPES
TESTIN
G
TYPES
TESTIN
G
TYPES
CHALLENGES AND BARRIERS
 Resources, timeline pressures, and materials comprise the most
common barriers to sufficient testing
 Liberating end users from their regular work for testing can prove
difficult
 Timeline pressures constitute a universal barrier to sufficient testing
 A third major barrier to testing success is inadequate script
development
SYSTEM LIFE
CYCLE TOOLS
OVERVIEW
 system life cycle (SCL) is continuous series of system
changes, or evolutions
a. Continuous analysis
b. Design and implementation of new modules
c. Upgrades and improvements
ANALYSIS AND
DOCUMENTATION OF THE
CURRENT PROCESS AND
WORKFLOW
 analyzing the data and workflow
a. As a way to understand how a system works
b. b. And how the different elements in the system interact
 ways to depict a workflow
a. The critical part is the analysis of the process or workflow
b. b. And accurately and completely documenting each step
 Documenting a workflow may be done by
a. Walking through the steps via an intensive interview with those intimately familiar with
the process
b. By observation
c. Or by a combination of the two
 provides the data with which you will base decisions that must
be made in the design, development, implementation, and
evaluation stages of the training project according to Kulhanek.
 A workflow diagram may be done to document the current
state when planning for a system implementation.
 documents the processes of the users, the interaction and flow
of the information system(s)
TYPES OF DIAGRAMS
a. Swim lanes
TYPES OF DIAGRAMS
a. DFD
SYSTEM SELECTION AND
IMPLEMENTATION
a. Enter information about the system
b. b. Monitor and be alerted to changes
SYSTEM IMPLEMENTATION
1. System implementation requires system design and building,
and testing
2. System design should involve key stakeholders, especially end
users throughout
3. Testing involves making sure that each part of the system
works, and that the system works correctly with other modules
and systems
SYSTEM OPTIMIZATION AND
METRICS
a. Assessing
b. Diagnosis
c. Planning
d. Implementation
e. Evaluation
MEASURING SUCCESS,
CONTINUING TO IMPROVE
 Continuous Quality Improvement (CQI) is based on the principle that there is an opportunity
for improvement in every process.
 CQI begins with a culture of change and improvement.
 CQI encourages all levels of staff to look for ways to improve the current process, and for
variations of the process, which can create errors
IMPLEMENTING CQI
PROGRAM
 Six Sigma
 Lean Six Sigma
 . Plan Do Study Act (PDSA)
 Failure Mode and Effects Analysis (FEMA)