Pediatric Informatics: Computer Applications in Child Health (Health ...

112 W.H. Drummond et al.
blood products, and specialized treatments are managed by an entity outside the
hospital that is not a part of existing inpatient CPOE system. Thus, these items must
be managed by (a) some parallel paper process, or (b) by a freestanding computer
system in a different hospital department, or (c) an independent external computer
system (diagnostic laboratory, blood bank, etc.). External systems may have a
standardized messaging interface that the legacy hospital system cannot support.
It is important to identify and think through all possible parallel and interactive
human, technical, and business processes well before CPOE implementation, otherwise
the implementations runs the risk of preventing providers from performing
needed actions and jeopardizing patient care. Hundreds of staff members may need
to be retrained for navigating the two (or more) partial processes.
8.3.6.2 Gap Analysis
New clinical information technology projects have historically routinely overlooked
key issues, people, and departments (e.g. Medical Records, or Admissions) in the
initial financial/installation planning. Such oversights are a common cause of severe
failures. Many implementation problems may be mitigated prospectively if they
are well framed during prespecifications functional assessment evaluation including
all department and roles within the institution. The assessment component
should include at least a 24-h observational visit to the physical departmental spaces
(including weekend and holidays to check for alternative workflows), meetings with:
(1) key people (the nurses and RTs) of the care units; (2) the supporting departments
(Pharmacy, Laboratory, Radiology, Admissions, Clinical Engineering); and (3) the
Information Technology managers and staff, who potentially would be involved with
any new system installation. The proposed scope of the new installation is important
in organizing the focus and composition of the teams responsible for planning,
specifications development, contracting, installation, education, and management.
The discovery process must address the stake holders’ needs and prioritize requirements
to withstand the contract development and budget negotiation processes.
Functional specification discovery and development is best undertaken early
in the overall process, to assure that all the important participants, technical needs
and workflow concerns are discovered (A good rule for implementation could be:
“Fail often but EARLY”). Functional specifications are easily developed as a log
of the walk throughs. A good example of formal functional specifications setting
effort is the Certification Commission on Health Information Technology (CCHIT).
CCHIT’s documents are publicly available. 84
Complex inpatient human systems and immature, not integrated CPOE, EMR,
and HIT products often prevent us from achieving the goal of safer patient care.
New software architecture, system designs, and workflow processes are all needed
to mange the parallel, multiaxial, temporally overlapping real-time “workflow” in
health care. When the target units are Pediatric Intensive Care Units, the list of main
considerations to guide the overall process should include the areas and situations
outlined in Table 8.5.