Implementing a perinatal clinical information system
Introduction: Implementation of a new clinical information system (CIS) is an extremely complex process. Seven aspects, vital to the successful implementation of a new CIS into a critical care setting, have been identified and published previously (Meadows 2003; Pare and Elam 1998). The purpose of this article is to discuss how the planning and implementation of a new perinatal CIS in the labor and delivery unit of a hospital was influenced by consideration of these 7 factors.
Design: Descriptive case study recounting one hospital’s experience with implementation of a clinical information system (CIS) in a labor and delivery unit over a 9-month period.
Measurements: The author discussed one hospital’s experience with implementation of a CIS within the framework of the following 7 published factors.
Factor 1: Defining the scope of the project and the associated goals Factor 2: Identifying the background, skills, and beliefs of the key players Factor 3: Assessing the unit’s strengths and weaknesses Factor 4: Assessing the current documentation system’s strengths and weaknesses Factor 5: Assessing the strengths and weaknesses of the perinatal CIS Factor 6: Determining the project’s constraints Factor 7: Discuss strategies for implementation
Results: Factor 1: A CIS system was already in place for archiving electronic fetal heart rate tracings. The specific goals identified on this unit were to expand the use of the CIS to include intrapartum nursing documentation and delivery records, which were deemed to be deficient. Factor 2: A clinical nurse specialist (CNS) was assigned to be project leader specifically because of her previous experience in using and supporting clinical information systems and managing projects. Factor 3: Staff perceived that documentation using the CIS would take longer, and they were very comfortable using a paper documentation system. Factor 4: The current paper documentation system did not meet JCAHO or AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses) standards. Factor 5: The CNS assigned to the CIS implementation project met with midwives and physicians to review that charting elements in the system and data fields reflected current unit practice, standard of care, were HIPAA and JCAHO compliant, and could be modified over time to reflect changes in practice. Areas that were identified as deficient were modified. Factor 6: The location and length of each classroom training session was problematic and had to be modified. Factor 7: A “go-live” date was set, a decision was made to determine how much of the CIS to utilize immediately and what to phase in over time, and a decision over how long to perform “double” documentation (documenting in both the CIS and standard paper forms at the same time) was made.
Conclusion: In reporting the experience at this hospital, the author concluded that the 7 aspects of planning CIS implementation identified in the literature contributed to the project’s success. Some phases of the project to longer than the anticipated 6 months and additional time is needed if the initial system selection and modification is to be part of the implementation timeline.
Meadows G. Implementing clinical IT in critical care: Keys to success. Nursing Economics 2003; 21: 89-90, 93.
Pare G, Elam J. Introducing information technology in the clinical setting: Lessons learned in a trauma center. International Journal of Technology Assessment in Health Care 1998; 14: 331-43.