Thanks to All CARING Volunteers Past, Present, and Future

CARING 

Vol. 20, No. 2 2nd Quarter, 2005 

ISSN: 1551-9104 

CARING is an organization advancing the delivery of quality healthcare 

through the integration of informatics in practice, education, 

administration and research with a focus on nursing. 

In This Issue: 

Thanks to All . . . . . . . . . . . . . . . 1 

President’s Message . . . . . . . . . . 1 

Upcoming CARING Events . . . . . . . 2 

Member News . . . . . . . . . . . . . . .2 

CARING Annual Meeting 

Highlights . . . . . . . . . . . . . . . . 3 

Correction on Treasurer’s Report . . 3 

International Informatics: 

The Chinese Experience . . . . . . 7 

Practical Advice for Systems 

Selection, Development and 

Implementation . . . . . . . . . . . .10 

©2005 The Capital Area Roundtable on 

Informatics in NursinG newsletter is produced 

with support from: 

Editor: Debra Derickson, MS, RN 

Newsletter Team for this Issue: 

Kathleen Crane, Bessie Richard, Cathy Turner, Bob Shea, 

Denise Tyler, Carolyn Averill 

CREATE 'n IMAGE 

Falls Church, VA 

Graphic Design • Clorinda Haug • 571.239.0589 

cmhaug@create-n-image.net • http://www.create-n-image.net 

Thanks to All CARING Volunteers 

Past, Present, and Future 

By Marina Douglas, MS, RN 

s I look back over the last 5 years as President and at the accomplishments of 

ACARING, I am inspired by all that our volunteer organization has 

accomplished. CARING has evolved into a thriving, fiscally self sufficient 

organization in an era where other nursing informatics organizations have been far 

less successful. CARING is recognized as a leading force, a collaborative partner 

and an innovator in Nursing Informatics. The CARING Job Bank is gaining 

national recognition as THE place for Informatics Nurses and companies looking 

for the highly skilled talent available in the CARING membership. The CARING 

website continues to evolve, with informatics nurses seeking specialized, up to 

date information. CARING has come a long way, baby! 

As with life, there were lumps and bumps and growing pains during these first 

years as an incorporated organization. There have been healthy disagreements and 

debate both within the Board and 

expressed by members on the listserv’s 

open forum. Issues affecting our 

profession were thoughtfully considered 

and ideas were shared. The stimulus for 

the formation of the Alliance for Nursing 

Informatics happened when it did, in 

large measure because of discussions on 

CARING’s listserv. It has been a great 

personal experience to be involved in this 

transformation. I am all too cognizant 

that such forward progress could not have 

happened without the willingness of so 

many to give of their time and talents. To 

all those who have actively participated, 

please accept my sincere thanks for your 

contributions. 

How wonderful for CARING and for 

me to be transitioning CARING’s 

presidency to Jerry Chamberlain. No 

doubt he will guide CARING to its next 

level of achievement with his enthusiasm, 

creativity, objectivity and gracious 

aplomb. I applaud Jerry and the rest of 

the members of the newly elected board. 

The infusion of new blood and ideas is 

critical to continued success. There is 

wisdom in reviewing the past while plans 

for the future are formulated. Only with 

the help of the membership will CARING 

continue to prosper. Again special thanks 

to all who have served on the Board 

during the past 5 years and 

congratulations to the new members of 

the Board of Directors. 

President’s Message 

By Jerry Chamberlain, MS, RN 

When colleagues ask me to describe 

CARING, I often begin by telling them 

that “CARING is the best $20 you can spend 

on your career.” This statement usually captures 

their interest and provokes a conversation into 

what CARING is all about and why it is so 

helpful to a career. 

Believe it or not, the origins of our 

organization go back more than 20 years to a 

meeting at what was then SCAMC (now 

AMIA). A few early pioneers recognized the 

need for group collaboration and education and 

began to recruit nurses from the Maryland, 

Virginia, and Washington DC regions. As the 

years progressed, and as our industry grew, so 

did CARING. Soon, we were incorporated and 

our membership was extended beyond the 

boundaries of the Washington DC metropolitan 

area. We quickly became the premier nursing 

informatics organization for education, 

resources, and peer networking. 

So why are my membership dues the best 

$20 I can spend on my career? For starters, I 

have access to nationally and internationally 

recognized speakers who discuss topics with 

direct relevance to my professional career. 

CPOE, Leapfrog, Usability, BCMA, Staff 

Scheduling. These concepts are driving the 

industry. Just last year, CARING held its first 

ever 1 1 ⁄2 day educational conference, offering 

up a wealth of new information as well as 9.3 

continuing education units. 

continued on page 2

By Susan K. Newbold, MS RNBC 

FAAN FHIMSS 

CARING Membership 

CARING currently has 887 members 

in 16 countries and 49 states. 

CARING is a founding member of 

the Alliance for Nursing 

Informatics (ANI) therefore you 

are an Alliance member through 

CARING. Susan K. Newbold is 

the CARING liaison to the ANI 

(www.allianceni.org). 

Degrees: 

Member News 

Mary O’Connor, Arnold, MD, successfully 

defended her dissertation, 

March 2005 at George Mason 

University and now holds a PhD. 

Her dissertation is titled, “The 

Center For Nursing Leadership: A 

Qualitative Study Describing The 

Impact And Meaning Of Life 

Changes of Individual Members.” 

Todd Swinderman, Boca Raton, FL, 

graduated from Florida Atlantic 

University, Boca Raton, FL, on 

May 06, 2005 with a Doctor of 

Nursing Science (DNS). “The 

Magnetic Appeal of Nurse 

Informaticians: Caring Attractor 

for Emergence” was a phenomenological-hermeneutic 

study 

informed by Chaos Theory within 

Complexity Sciences and Ray’s 

Bureaucratic Caring Theory. 

Marissa Wilson, Baltimore, MD, 

defended her dissertation May 

2005 and received her DNS degree 

from Johns Hopkins University, 

Baltimore, MD. Her dissertation 

was “Physical, Psychological, and 

Social Environmental Factors 

Associated with Disability in 

Community Residing Elders.” 

Debra Lynch, Egg Harbor Twp, NJ, 

graduated with a Post-Master’s 

Certificate in Nursing Informatics 

from Duke University School of 

Nursing. 

Message from the President 

continued from page 1 

But that’s not all. My membership in CARING also brings forth access to a 

repository of informatics knowledge. By logging into www.caringonline.org I 

have access to quarterly newsletters, past presentation materials, and an on-line 

career job board. In addition to providing updates on other members and meeting 

minutes, the newsletter is another source of education as it usually contains a new 

article or book review highlighting innovative trends and ideas. I frequently log 

into the website to review past presentations and search for specific knowledge on 

a topic. Last week I reviewed Sandra Trakowski’s presentation on wireless mobile 

technology and bar codes to prepare me for an upcoming conversation with our 

medication administration team. And…let’s not forget the CARING Job Bank. 

With an average of 2 - 4 new postings each month, I am able to keep tabs on new 

opportunities and evaluate my career development. 

Last, but certainly not least, the benefits of membership include a vast network 

of colleagues, friends, and mentors. With an ever-growing membership, CARING 

provides access to other healthcare informatics professionals outside of my own 

organization. If I run into a challenge at work, I know that I have access to a 

membership of almost 1,000 colleagues who will provide guidance and past 

experience. 

After I finish explaining all the benefits of membership and why my colleague 

should join CARING, I am sometimes asked “How can your organization provide 

all of this for just $20.00 a year?” That’s when I hit them with the fact that we are 

a 100% volunteer organization. 

I would like to extend a warm thank you to our outgoing board members – 

Sheryl Taylor, Nicole Kerkenbush, and Caterina Lasome – who transitioned off of 

the board this past April to make way for three new members. Each gave their 

time and expertise to help CARING grow, mature, and succeed into the 

organization we have today. Please join me in extending our appreciation for their 

time and service. Filling these vacant seats are our newest members of the board: 

Janice Henson, Amy Jacobs, and Patrick Shannon. These new leaders have 

volunteered to take the baton to keep our organization moving forward. 

In closing, I would like to extend a very warm declaration of gratitude to our 

outgoing Board President, Marina Douglas. Marina accepted the role in April of 

2000 and for the past five years has volunteered incalculable hours and effort and 

to advance our professional organization. My deepest thanks for her commitment, 

she is part of the reason my $20 goes such a long way!! 

Upcoming CARING events: 

Planned Networking Events 

• July 22, 2005—CARING member dinner at the Summer Institute in Nursing 

Informatics. Location and Time TBD 

Planned Educational Events 

• October 22, 2005—AMIA Nursing Informatics Symposium (held in 

conjunction with the ANI). 

• October 24, 2005—CARING Lunch at the AMIA conference 

continued on page 3 

CARING • Page 2

CARING Annual Meeting Highlights 

Contributed by Debra Derickson 

Business Meeting 

embers of CARING held their annual meeting on April 23, 2005 at Suburban 

MHospital Conference Center in Bethesda, Maryland. A buffet lunch sponsored 

by CARING was served to on-site attendees. Many thanks and appreciation goes 

to Helen Siedel for organizing the logistics of the meeting and to Suburban 

Hospital for providing a lovely meeting space in their conference center. Many 

thanks also go to those from the Cerner Corporation who donated the services and 

support to provide web and voice conferencing for offsite attendees. 

The business meeting provided an overview of CARING’s accomplishments 

over the past year, as well as plans and goals for the coming year. Joyce 

Sensmeier, Director of Professional Services at Healthcare Information and 

Management Systems Society (HIMSS) and also Co-Chair of Alliance for Nursing 

Informatics (ANI), was the guest speaker to provide an update on the latest 

activities and direction of the newly formed ANI. 

CARING has a vested interest in this alliance 

because CARING members provided a major 

impetus and were substantial contributors to the 

formation of ANI. 

(CARING members may access the slides from 

the business meeting and the speaker’s presentation 

slides on CARING’s website – 

www.caringonline.org – in the library section.) A 

summary of the meeting is provided here. 

Elections: 

Online elections were held this year. 

Congratulations to the three new board members elected for 2005: 

• Janice Henson 

• Amy Jacobs 

• Patrick Shannon 

Thanks and appreciation to 

the three outgoing members for 

their past service on the 

CARING board: 

• Nicole Kerkenbush 

• Catrina Lasome 

• Sheryl Taylor 

Joyce Sensmeier 

Member News 

Bessie P. Richard, Houma, LA, 

graduated May 2005 with a 

Masters of Science in Nursing 

Informatics from Duke University. 

Congratulations to the May 2005 

Masters graduates from the 

University of Maryland Baltimore 

School of Nursing. Their focus is 

Nursing Informatics. Judith 

Breitenbach, Glen Arm, MD, 

Andrea Deickman, Berlin, MD, 

Judith Levi, Rockville, MD, 

Rosemarie Sellick, Sea Girt, NJ, 

Angela Stone, Baltimore, MD, 

Marcy Stoots, Poolsville, MD, 

Wendy Walecka, Winchester, VA, 

and Jason Windsor, Alexandria, 

VA. 

Amber Oliver, Woodbine, IA earned 

her BSN in May from the 

Nebraska Wesleyan University. 

She is now enrolled in a Masters in 

Healthcare Administration program 

with an anticipated graduation date 

of May 2006. 

Certification in Nursing 

Informatics (NI) by the American 

Nurses Credentialing Center: 

Rose Almonte, Lansdowne, VA was 

certified in NI March 12, 2005. 

Alicia A. Bradford, Bowie, MD 

passed the informatics examination 

in February, 2005 and Stephen W. 

Prouse, Baltimore, MD was certified 

in NI March 2005. 

Left to Right: Janice Hensen, Amy Jacobs, Patrick Shannon 


Certified Professional Coder 

(CPC) certification: 

Correction on Treasurer’s Report: 

In the last CARING newsletter the treasurer’s report incorrectly quoted that 

2004 revenue exceed expenses by $4,386.00. The report should have stated 

that 2004 revenue exceeded expenses by $18,883.37. 

Susan C. Carson, Alpharetta, GA. 

CPC is granted through the 

American Academy of Professional 

Coders (AAPC). 

Page 3 • 2nd Quarter 2005 

continued on page 4

More Member News 

Certified Professional in 

Healthcare Information and 

Management Systems (CPHIMS): 

Bessie P. Richard, Houma, LA 

recently earned the CPHIMS 

Certification from Healthcare 

Information and Management 

Systems Society (HIMSS). 

Awards and Honors: 

Martha Bergren, was recognized in 

2004 by the National Association 

of School Nurses. This was for 

significant efforts to shape policy 

and disseminate information 

regarding the interface of the 

Health Insurance Portability and 

Accountability Act and the Family 

Educational Rights and Privacy 

Act (HIPAA-FERPA). 

Karen Courtney, Columbia, MO, 

received the Sinclair School of 

Nursing PhD Graduate Student 

Award for Overall Excellence at 

the 2005 annual banquet. 

Margaret Maag, Sausalito, CA, was 

this year’s recipient of the Teacher 

Effectiveness Award at the 

University of San Francisco School 

of Nursing. 

Peter Murray, Nocton, Lincoln, UK, 

was awarded the Eighth Annual 

Recognition Award for 

Advancement of Computer 

Technology in Healthcare. The 

award was made by Rutgers, the 

State University’s College of 

Nursing Center for Professional 

Development at their annual international 

nursing computer and 

technology conference in Atlanta, 

GA, in April 2005. Peter is the first 

nurse from outside the US to 

receive the award. 

Susan K. Newbold, Columbia, MD, 

received the graduate scholarship 

from the HIMSS-National Capital 

Area chapter in May 2005. 


continued from Page 3 

CARING 2004 Activities: 

• Membership Committee : During 2004 membership did reach 1000 

members, with member representation from 50 states and 14 countries. Due 

to non-renewals as of the end of the year, the total has now declined slightly. 

The CARING online directory was also updated in October 2004. 

• Web Committee : A search is in progress to find a new webmaster, as our 

current webmaster, Stephen Prouse, after several years, wishes to resign 

from this role. 

One hundred seventy-six CARING members completed a seven-question web 

survey that was conducted to determine what features of the current website have 

been helpful. 

Results: 

• Most useful feature – Job Bank 

• Least useful feature – Chat Room 

• Job Bank : During 2004, 28 companies or organizations had job postings in 

the Job Bank which resulted in $9,195 of revenue to CARING. This 

represents an increase of 21% from 2003. Three of these companies posted 

more than one position or posted more than one per month. Feedback from 

those posting positions is that CARING’s Job Bank provides a valuable 

service. During the first quarter of 2005, 15 new job postings have been 

listed, which has exceeded expectations. 

• One and One Half Day Educational Conference : CARING coordinated an 

ambitious educational conference targeted for the advanced informatics 

practitioner in November 2004. Topics included wireless security, device 

connection, HL7 as a tool for requirements definition, single sign-on and 

context management. The event was co-sponsored by Georgetown 

University and was held on the Georgetown campus in Washington, D.C. 

More detail about this event can be found in the Volume 19, #4 issue of the 

CARING newsletter. 

CARING’s Strategic Goals: 

• Recognition as a major resource center for nursing informatics 

• Recognition for providing quality professional development activities for 

nursing informatics 

• Recognition of our web site for excellence in both form and content 

• Attain fiscal independence 

• Achieve a paid membership of 975 

CARING’s Objectives: 

• Provide educational experiences including contact hours events 

• Publish educational and informational articles 

• Act as a clearinghouse for seminars, positions and speakers 

• Provide a network for healthcare information systems professionals 






2005/2006 CARING Meeting Schedule: 

The schedule is still in the planning stages. If any member has specific ideas or 

topics of interest for meetings, please contact Sharon Neilsen at scnilsen@cox.net. 

Sharon has volunteered to coordinate planning of the meetings. 

A proposed schedule is as follows: 

• June 2005– meeting in D.C. 

• September 2005– meeting in Baltimore 

• November 2005– meeting in Virginia 

• February 2006 – HIMSS Conference with CARING activities 

• March 2006- Joint Meeting 

• April 2006– Annual CARING Meeting 

Summary of the Presentation on the Alliance for Nursing Informatics 

Guest speaker: Joyce Sensmeier, MS, RN, BC, CPHIMS, Co-chairperson of the 

ANI Steering Committee. Joyce presented background information on the history, 

purpose and objectives of the ANI. A question and answer period followed to 

stimulate discussion related to the relationship that ANI will have with member 

organizations, and how ANI might communicate with and support their member 

organizations. 

About ANI: 

• Founded in 2004; a collaborative gathering of all known nursing informatics 

organizations in the US with an intent to advance the efforts of nursing 

informatics professionals 

• Strives to speak with one voice on nursing informatics issues and 

opportunities of national import 

• Provides a mechanism for transforming care, developing resources, 

guidelines and standards for nursing informatics practice, education, scope 

of practice, research, certification, public policy, terminology, best practice 

guidelines, mentoring, advocacy, networking and career services 

• Supports Full or Affiliate Memberships of local, regional or national nursing 

informatics organizations 

• Sponsored jointly by AMIA and HIMSS to provide the infrastructure and 

staff necessary to support ANI initiatives 

• Organizational Structure — a Steering Committee (two co-chairpersons and 

three Members-at-Large) and a body of Governing Directors (one 

representative from each participating organization) 

• Currently developing an ANI website; unveiled a new ANI logo 

Ideas, questions, and comments and suggestions from CARING members to 

Joyce Sensmeier: 

Joyce encouraged participants at the meeting to generate lots of ideas, 

questions, and suggestions so that she can incorporate these items in future 

discussions and planning for what ANI is to become. This is a summary of the 

ideas discussed at the annual meeting. 



Linda S. Potter, Gurnee, IL and 

Joyce Sensmeier, LaGrange, IL, 

were selected to be HIMSS 

Fellows in April 2005. 

Patrick G. Shannon, Springfield, 

VA was promoted to Lt. Col. in the 

US Army February 2005. 

Bruce K. Wilson, Edinburg, TX, 

received the Luther Christman 

award for his work with the history 

of men in nursing. 

Amber Oliver, Woodbine, IA, was 

inducted into Sigma Theta Tau 

May 2005. 

Azizeh K. Sowan, Baltimore, MD, 

Yen-Chiao “Angel” Lu, 

Columbia, MD, and Ann E. 

Smith-Flango, Hollidaysburg, PA, 

were inducted in the Pi Chapter of 

Sigma Theta Tau International 

Honor Society of Nursing May 15, 

2005. The Chapter is at the 

University of Maryland, Baltimore. 

Presentations: 

Marion J. Ball, Baltimore, MD, 

Debra J. Konicek, Wauconda, IL, 

and Susan K. Newbold, 

Columbia, MD, presented at the 

Minnesota Nursing INformatics 

Group (MINING) conference in 

Minneapolis, MN, May 2005. 

Karen Courtney, Columbia, MO, 

presented a poster and will present 

a paper: Courtney, K.L. (April 

2005) Missouri nurse recruitment 

and retention policy evaluation 

(1991-2001). Sinclair School of 

Nursing representative, Midwest 

Nursing Research Society 29th 

Annual Research Conference, 

Cincinnati, OH [poster]. 


continued on page 6


Courtney, K.L., Demiris, G., 

Craven, C.K., Parker Oliver, D. & 

Porock, D. (2005). Exploring electronic 

conversion of behavioral 

instruments for telehealth. Paper 

accepted at XIX International 

Congress of the European 

Federation of Medical Informatics, 

Geneva, Switzerland. 

Tammy C. Grubbs, Leesville, SC, 

will present “Wireless: Is it Worth 

It?” at the Picis User Group 

Conference in Boston, MA, June 

14, 2005. She was featured in 

Health Data Management 

Magazine in March, 2005 (www. 

healthdatamanagement.com). 

Susan K. Newbold, Columbia, MD, 

spoke about “What every Nurse 

Manager Needs to Know about 

Informatics” at the Bootcamp for 

Nurse Managers, sponsored by 

Cross Country University in Glen 

Allen, VA, in May 2005. 

Marco Zeimet, West London, UK, 

presented at the Med-e-Tel 2005 

(www.medetel.lu) Telemedicine 

conference on April 7 in 

Luxembourg. Marco is currently a 

PhD Research Student at Brunel 

University, West London. 

“Optimum Design for a 

Teleconsultation System” was the 

topic (by M. Clarke and M. 

Zeimet). Find the information in 

original: http://www.medetel.lu/ 

education/program.html 



Topics on Communication: 

• Determine prioritization of issues from all NI groups as members of ANI 

and disseminate those priorities back to the ANI membership. 

• Support a robust ANI listserv along with an archive of discussions by topic– 

link communications to the member organizations. A listserv archive is 

currently not available using CARING’s current communication tools, but is 

greatly desired. 

• Communications hosting – providing space/access to web site tools, content 

tools 

• Help dialog occur with clients, organizations, federal and state initiatives 

Topics on Collaborative Efforts: 

• Develop a Speakers Bureau 

– Expertise areas/ topics 

– A collection of information for others 

– Mentoring opportunities 

– Electronic Access with decreased cost 

– Criteria for approval of a speaker on behalf of ANI 

• Support and assist with state level of involvement for home health initiatives 

and Regional Health Information Organizations 

• Work to promote terminology/taxonomy standardization 

• Get vendors more involved in the efforts for vocabulary standardization 

• Focus/coordinate vendors on nursing/patient issues 

• Provide an avenue for collaboration with other professional groups to 

provide nursing input to design for vocabulary and evidenced-based practice 

• Help vendors focus on product / system usability – with staff nurse input to 

design features that assist in getting their jobs done 

Questions: 

• How will the budgeting of new projects be handled by ANI? 

• Where will funding for ANI come from? 

• How should CARING participate with ANI in terms of providing money? 

• How should CARING participate with ANI in terms of providing content for 

ANI initiatives? 

• How might CARING Job Bank (for announcement of positions) be made 

available to the other 18 Nursing Informatics groups? 

Participants at the CARING Annual Meeting 

Fern Malila, Oakton, VA, presented 

“Decision Support: Beyond 

Medications” at Toward an 

Electronic Patient Record (TEPR) 

conference in May 2005 in Salt 

Lake City, UT. 




Publications: 

U.S. informatics delegation to China 

International Informatics: The Chinese Experience 

Author: Patricia A Abbott 

PhD, MSIS, RNBC, FAAN, ACMI 

Johns Hopkins University School of Nursing 

China. The awakening giant, home of the world’s largest population and the 

emerging economic superpower. With 1.3 billion people, burgeoning health 

problems, and an aging population, China is gearing up their informatics engines 

and putting the power of their collective minds to work. In anticipation of the 

explosion of informatics in China, 23 US informaticians headed to China last fall 

to survey and consult with like-minded Chinese about healthcare information 

technology (IT). 

Our delegation was comprised of nurses, physicians, informatics and computer 

scientists, academics, practitioners, and consultants from the informatics realm. 

The trip was part of the International People to People program, and was the first 

ever organized by People to People around the theme of Informatics. To be frank, 

it was a challenging trip to plan. Although not considered a “new” specialty by 

many reading this article, there are still many in the US who struggle to 

understand what informatics is – and what it is not. Compound this exponentially 

by trying to arrange an informatics delegation to another country, throwing in 

language and cultural differences! The end result however was a visit that was 

challenging, phenomenally interesting, and personally rewarding. 

In participating in a People-to-People program, participants are allowed to 

either book their own airline ticket or meet in a departing city (ours was LA) and 

travel en masse. Many of us ended up on the same flight from LA to Beijing 

where we were met by our Chinese national representative, Tony Zhao. As the 

purpose of People to People International is to “enhance international 

understanding and friendship through educational, cultural and humanitarian 

activities involving the exchange of ideas and experiences directly among peoples 

of different countries and diverse cultures”, we spent the first evening learning 

very rudimentary Chinese expressions, getting briefed on culture and customs, and 

learning how to gracefully eat with chopsticks. We coalesced that evening into a 

jolly group of informaticians, forming new friendships, sharing interests, and 

setting goals for our visits. 

While in Beijing, we met with the China Medical Informatics Association 

(CMIA) leadership team. The CMIA is the counterpart to the American Medical 

Informatics Association (AMIA). Our team also visited the Capital University of 

Medical Sciences, and the Peking Union Medical 

College. Both of these Universities are the intellectual 

powerhouses for health sciences in China, and both 



Martha Bergren, Chicago, IL, 

Sharon McLane, Missouri City, TX 

and Karen S Martin, Omaha, NE 

are published authors. 

Schwab, N. C., Ruben, M., Maire, J. 

A., Gelfman, M. H. B, Bergren, 

M. D., Mazyck, D. & Hine, B. 

(2005). Protecting and sharing student 

health information: 

Guidelines for developing school 

district policies and procedures. 

Kent, OH: American School 

Health Association. 

Bergren, M. D. (2004). Privacy 

questions from practicing nurses: 

Answers from an expert. Journal 

of School Nursing, 20, 296-301. 

McLane, S. (2005). A Day in the 

Life of a Manager: Incorporating 

Leadership, Mentoring, and Role 

Modeling. Oncology Nursing 

Forum 32(1): 23-25. 

McLane, S. (2005). Designing an 

EMR planning process based on 

staff attitudes toward and opinions 

about computers in healthcare. 

Computers, Informatics, Nursing, 

23(2), 85-92. 

Martin, KS. (2005). The Omaha 

System: A Key to Practice, 

Documentation, and Information 

Management (2nd ed.). St. Louis: 

Elsevier. 

Kenneth Andersen, Apollo Beach, 

FL was pictured in the Healthcare 

IT News April 2005 in an article 

called, “Ironing out the wrinkles in 

the OR.” 

Suzanne C. Beyea, Grantham, NH, 

Dana M. Womack, Westminster, 

MD, and Susan K. Newbold, 

Columbia, MD, were quoted in an 

AJN article regarding technology 

and nursing. Trossman, S. (2005). 

Bold new world. American Journal 

of Nursing, 105(5), p. 75. 

continued on page 8


Neat Stuff: 

Connie White Delaney, North 

Liberty, IA, was appointed the 

Dean of the University of 

Minnesota School of Nursing in 

May. 

Joni Fernbaugh, White Plains, MD, 

finished her Masters of Science in 

Information Technology at George 

Washington University in 2003. 

She recently moved from SAIC to 

the Department of Defense in the 

role of Medical Business 

Development Manager for Bearing 

Point’s Health Services Sector. 

Mimi M. Hassett, Housatonic, MA, 

has accepted a position of Director 

for Clinical Informatics, Berkshire 

Healthcare Systems in Western, 

MA, and will start in June. 

Amber Oliver, Woodbine, IA, began 

a new position at St.Lukes 

Regional Medical Center, Sioux 

City, IA, as a Clinical Nurse 

Specialist – Informatics. 

Marcy Stoots, Poolsville, MD, is 

newly employed as an Application 

Analyst at Computer Sciences 

Corporation and is working on the 

National Institutes of Health (NIH) 

installation. 

Many CARING members are speaking 

and attending the Summer 

Institute in Nursing Informatics 

July 20-23, 2005 (http://nursing. 

umaryland.edu/informatics/) in 

Baltimore, MD. Sign up for the 

CARING dinner July 22 with 

snewbold@umaryland.edu. 

For information on healthcare and 

nursing informatics conferences, 

see www.nursing.umaryland. 

edu/~snewbold/sknconf.htm 

Please send items of interest for 

future CARING newsletters to: 

Susan K. Newbold, 

snewbold@umaryland.edu 



stand poised to provide fuel for the growth of intellectual informatics in China. 

We also met with members of the Telemedicine Center of Number 310 Military 

Hospital, where we learned about telehealth applications being used by the 

Chinese military. China stands at the brink of harnessing informatics, yet we 

quickly determined that the US understanding of informatics and the Chinese 

understanding of informatics were 

quite different. Examples of some of 

these differences are described later 

in this article. 

As part of the cultural exchange 

aspect of the trip, while in Beijing, 

our delegation also experienced the 

Peking Opera, the Forbidden City, 

Tiananmen Square, and the Great 

Wall of China. Beijing, the site of the 

upcoming Olympics, is in full swing 

modernizing for the Games. Massive 

public works projects are underway, 

including the movement of large 

coal-burning power plants to more 

remote areas in an attempt to 

improve the air quality. While having 

our formal picture taken in 

Tiananmen Square, a misguided and 

distraught woman attempted suicide 

by slashing her wrists in a political 

protest. We believe that had she 

known we were nurses and doctors 

that she would have made this 

attempt elsewhere! It was interesting 

to note that even though we were all 

informaticians, we are still healthcare 

providers in our soul – tourniquets 

were applied and care given until an 

ambulance arrived. Not once did I 

hear anyone say “reboot”! 

Our trip continued as we all flew 

to Chongqing, the world’s most 

populated city. Chongqing is the site 

of the Three Gorges Dam, and it sits on the steep hills above the confluence of the 

Yangtze and Jialing Rivers. While in Chongqing, we visited the First Affiliated 

Hospital of the Third Military Medical University, where we met with the Director 

of the Nursing Departments, and the Director of the Hospital. This very modern 

and beautiful hospital rivaled those seen in the West. Of particular interest was the 

Neonatal Intensive Care Unit (NICU). Parents are not allowed into the NICU, so 

the Chinese have created tele-visiting facilities where the parents can sit at a 

monitor and visually observe their babies. While this does not substitute for 

hands-on, it is an interesting technological compromise that offers some solace to 

concerned parents. In Chongqing, we also visited a 

rural elementary school, a rural village, and the Dazu 

Stone Carvings (a United Nations Educational, 

Scientific and Cultural Organization World Cultural 

“We quickly 

determined that 

the U.S. 

understanding of 

informatics and 

the Chinese 

understanding of 

informatics were 

quite different... 

[But] China... 

stands poised to 

make its mark on 

global healthcare 

informatics.” 





Heritage site). The elementary school was very poor by US standards, the rooms 

do not have heat and the children work on small chalkboards, but the children 

were bright and eager to learn. They entertained us by singing the Chinese 

national anthem, we made them laugh with our terribly off-key rendition of “My 

Country ‘Tis of Thee”. 

Our final stop was in Shanghai, which looks remarkably like any large western 

city. It is the fourth largest 

city in the world. In Shanghai 

was visited the Shanghai Jioa 

Tong University, the Fudan 

University Medical College, 

and the Shanghai 

Bioinformatics Center. These 

highly advanced settings are 

home to much of China’s 

work in computational 

biology, genomics, and 

proteomics. Shanghai is also a 

shopper’s paradise, so our 

delegation actually spent the 

last afternoon of our time in 

China shopping at “China 

Town” in Shanghai. 

So, what is the summation 

of the trip? In my opinion, 

informatics in China is about 

where the US was 20 years ago – in some respects. The word “informatics” in 

China is still viewed primarily as signal and image processing, number crunching, 

and computational analysis. We did not see informatics as we know it deployed 

routinely in the patient care setting. We did see examples of digital x-ray (PACS), 

but only in a few of the more advanced “showcase” settings. There are advanced 

sites that are at the experimental stages with informatics actually woven into the 

care process, but again, these are primarily at the “showcase” sites such as the 

Peking Union Medical College (PUMC) in Beijing. 

Where is nursing informatics in China? It would be best to first talk about 

where nursing is in China. Nursing in China is growing. Johns Hopkins School of 

Nursing just initiated the first PhD program for nurses 

located in China in the Spring of 2005 at (PUMC). The 

number of nurses with advanced degrees in China is 

very low, which impacts the growth of nursing 

informatics within the country and has prevented 

nursing in China from making the same types of 

advances as nursing in other countries. Questions 

about the nursing use of IT in China were occasionally 

met with a bit of a confused look – primarily because 

the use of IT in healthcare in China is quite rare, 

dominated by physicians and computer scientists, and 

focused primarily on computationally complex tasks 

such as image processing. However, this is changing in 

China. Growth of nursing programs and the awareness 

of the Chinese people of the importance of informatics 

Left to Right: 

Co-Director and Director of First Affiliated Hospital Number 3, Military 

Medical University, Patti Abbott, Charles Friedman, Jane Markley 

is rapidly transforming the healthcare 

scene. The increase of the middle 

class in China, the movement towards 

less reliance on the government for 

healthcare, movement toward 

capitalism with “Chinese 

characteristics”, the growing 

influence of Western medicine, and 

the Severe Acute Respiratory 

Syndrome (SARS) scare of 2003 has 

resulted in increasing interest in 

informatics and biosurveillance in 

China. China, with its massive 

population, economic power, 

authoritarian government, and 

intellectual capital stands poised to 

make its mark on global healthcare 

informatics. 

Many of our delegation have 

parleyed the visit into ongoing 

relationships. The CMIA is ending a 

delegation of 15 top Informaticians to 

the fall meeting of AMIA in late 

October of 2005 to collaborate and 

enhance relationship with US 

counterparts. We hope that the 

connections between US Universities 

and members of our delegation may 

influence the growth of Nursing 

Informatics in China. Regardless, our 

delegation was given the chance to 

look into the Chinese informatics 

engine. We were given a glimpse that 

we are not soon to forget. 

Children from the Elementary School in Dazu 

Page 9 • 2nd Quarter 2005

Practical Advice for System Selection, Development and Implementation 

Authors of Article: 

Eleanor Callahan Hunt MSN, RN, BC 

Clinical Informatics Analyst, Research and Development: Electronic Medical Record Solutions 

Misys Healthcare System, Raleigh, NC 

Rebecca Kitzmiller, MAJ, MHR, MSN, RN, BC 

Director, Department of Nursing Informatics 

Duke Health Technology Solutions 

Duke University Health System 

Lieutenant Colonel Sara Breckenridge Sproat, MSN, RN, BC 

US Army Nurse Corps 

Deputy Director, Division of Regulated Activities 

Walter Reed Army Institute of Research, Silver Spring, MD 

Acknowledgements: 

The content of this article is the opinion of the authors only and do not reflect those of the US 

Army Medical Department or the US Army. 

Overview 

How does one fit advice on the 

entire process of implementing a 

system in healthcare into a single 

article? The short answer is that it is 

impossible. What is provided here are 

important highlights, with the hope 

that novices will have their interests 

piqued and will review the literature 

for details; and that those more 

experienced will have their thoughts 

provoked to include or improve steps 

that may have been passed over in the 

necessity of meeting milestones. The 

literature is comprehensive on any 

one of these sections, should more 

detail be required or desired. 

Practical advice for system 

selection, development and 

implementation of any kind of system 

in healthcare is a hot topic within and 

outside of healthcare. The nursing 

profession has a long history of 

involvement in both system 

implementation and project 

implementation, and is well suited to 

these tasks. The processes and steps 

of assessment, diagnosis, planning, 

implementation, and evaluation used 

in the nursing process to manage a 

patient’s plan of care are analogous to 

the steps used in system 

implementation (See Table 1) 

(AuCoin & Kitzmiller, 2004; Hunt, 

Breckenridge-Sproat, & Kitzmiller, 

2004). The nursing process and 

system implementation are both 

inherently dynamic in nature and 

involve frequent clear 

communication, multi-tasking, risk 

assessment, education, and training. 

Requirements 

and System Selection 

“The processes 

and steps of 

assessment, 

diagnosis, 

planning, 

implementation, 

and evaluation 

used in the 

nursing process 

to manage a 

If defining the vision, mission and 

goals of the project for the intended 

patient’s plan of 

system has not been done, STOP and 

back up to include this step. One care are 

cannot manage a project that is a 

moving target, and that is what the analogous to the 

project will be until it is well defined. 

In addition, define the following steps used in 

project components: 

• System scope 

system 

• Practice arena 

implementation.” 

• Purpose 

• Rough timeline for installation 

• Rollout approach 

• Budget 

• Project stakeholders and decision maker(s) 

This essential step serves several purposes-it helps to articulate leadership’s 

support of the system, grounds the to-be-selected system to organizational 

strategic and operational objectives, and establishes precedence among potentially 

competing corporate priorities (Hunt et al., 2004). 

Open communication with stakeholders involved in the selection, purchase 

decision, design and implementation of the system is critical. Share the vision, 

mission, goals and scope of the project. Key stakeholders are responsible for 

identifying primary requirements of a system and for communicating 

organizational and operational changes that affect those requirements. Develop a 

communication plan to keep key stakeholders on board with the vision, mission, 

and goals (Schwalbe, 2002). Face-to-face meetings, 





virtual meetings, and conference calls are essential methods of communicating 

and serve to keep the project on time and stakeholders informed. 

What type of system is being replaced? Is it a manual system, a paper based 

system, or a previous version of a computerized system? Research the 

marketplace to define additional requirements of the system. Determine a build or 

buy decision, if the option is to buy, initiate a request for proposal (RFP). If the 

decision is to build, determine if the effort will use internal development staff, 

utilize a vendor partnership, a contractor, or a blend of these. Is the intent to resell 

the system after it is built or to keep it internal? Reexamine the scope of the 

project based on organizational expectations and operational constraints. Is the 

project still feasible given the budget, timeline and personnel assigned? Perform a 

risk assessment. Based on identified requirements, write a request for information 

(RFI) and send it to vendors. 

While waiting for the RFI to be returned, engage stakeholders in high-level 

requirements gathering. Ensure requirements are identified and communication 

occurs at all levels from end users up to higher levels of management. 

Requirements should adequately and completely describe business and operational 

processes the system will support. Using these high-level requirements, evaluate 

the information that returns from the RFI solicitation. The specifics of 

requirements gathering depends upon the type of system and the number of users 

impacted. For example, a computerized order entry system has a larger effect on 

an organization than a department-based internal documentation system. The 

further reaching the effects, the more that users may need management or 

coaching to mitigate the potential adverse effects of the changes. 

Write an RFP based on the high-level requirements and the information from 

the RFI process. Determine common workflow and requirements across the 

institution and build case examples and scenarios of the workflow processes in the 

organization. These will be used throughout the project life cycle: during vendor 

demonstrations, system design and development, testing, and training (Hunt et al., 

2004; Schwalbe, 2002). 

Send the RFP to vendors you have selected to search for potential pre-existing 

systems. Use the established case scenarios during an evaluation of each vendor 

system to support uniform comparison. Select the system, negotiate the contract, 

and get your last good night’s sleep. Things are ready to rock and roll! 

Planning 

Revisit the implementation plan and timeline during contract negotiations to 

ensure it is possible to remain within budget considering staffing, design and 

training constraints. Determine who will be implementing the system. Share and 

continue to communicate expected steps and forecast expectations. Involve end 

users early and often to set expectations and to lessen the impact of change and 

resistance that will occur as a result of the system implementation. Have key 

stakeholders attend staff meetings during all shifts to give staff an opportunity to 

ask questions (Hampton Group, 2003). Ensure staff feedback reaches you and is 

incorporated into the RFP, training documents, roll out plans, and 

design/development or file builds. Contact other sites that have implemented the 

same system in similar environments. Listen to their implementation stories and 

incorporate lessons learned into the implementation plan. Realize that you are not 

the first to implement a system. The initial reaction to a problem should be to take 

a deep breath, realize others have done this before, and have survived. Why 

reinvent the wheel? Ask them how 

they did it. If a response is not 

received or if it is a unique situation, 

check with the informatics 

community for advice. Leverage the 

expertise that surrounds you. 

Implementation 

Conduct the implementation phase: 

testing, training and deployment of 

the system with several things in 

mind. Test, using the developed work 

processes established during the 

requirements gathering phase. 

Continue to compare established 

requirements with actual operational 

processes and be prepared to 

accommodate differences by either 

configuring the system or changing 

end users’ workflow. Communication 

of critical day to day workflow 

elements are required for system 

configuration in order to implement a 

system that is reflective of current 

practice. Training should follow adult 

learning principles and provide the 

information the user needs fairly 

close to go-live. 

Begin coordination and 

development of policies, procedures, 

training and rollout plans. 

Communicate these plans; support for 

the system rollout and ongoing use 

needs to be planned and staffed at all 

levels. The goal is to minimize 

negative impact on patient care 

settings. Include frequent status 

updates, ongoing risk assessments, 

and communication with 

stakeholders, with special emphasis 

on early notification of changes to 

normal operations. Frequent rounding 

or walk-through by the project team 

throughout the affected areas ensures 

ongoing communication. 

Once system configuration is 

complete, users are trained, data is 

preloaded into the system and you go 





live–you are NOT done. System 

deployment must include support for 

users that match their work schedule. 

For example, support should be 

provided 24 hours per day for units 

that function 24 hours per day. 

Feedback needs to be incorporated 

back into the system. Thank and 

appreciate your volunteers and 

recruits (often assigned as super 

users). Understand that their first 

priority is patient care and operations 

supporting patient care. It is not easy 

for staff to balance the needs of daily 

operations with the needs of a system 

implementation. Encourage 

recognition of various levels of effort; 

always give positive feedback and 

recognition for a job well done. 

Evaluation 

Plan on revisiting implemented areas to observe how end users are using the 

system. Regular enhancements to the system will be needed to tweak the system 

to enhance workflow as well as reflect practice changes. Watch users using the 

system. Often, you might be surprised that they are using a long way to 

accomplish ordering or charting a medication, instead of using a quicker way. At 

other times, you may be surprised by what they are doing with the system and you 

may learn something from the users. Be aware, most users need to perceive an 

overall positive effect to be satisfied. Often they do not remember what life was 

like before implementation and they may need to be reminded. Celebrate success! 

Collect help-desk feedback; examine user calls for additional training 

opportunities or system configuration changes. Correct and re-educate users on 

system functionality, and consider implementing functionality that was not 

installed initially. Revisit the intended outcomes for the system and ensure capture 

of outcomes data. Choose your evaluation criteria early to ensure that meaningful 

data are captured. Gather pre- and post-implementation data and evaluate 

expected outcomes and related statistics. These data 


Table 1: Comparison of Nursing Process and System Implementation Phases 

Nursing Process 

System Implementation Phases 

Assessment 

Requirements 

Needs Assessment 

Vision, Mission, Goals 

Scope, Timeline, Resources 

Stakeholders 

Budget 

Diagnosis 

System Selection 

RFI, RFP 

Demonstration, Site visits 

Contract 

Planning 

Planning/Design 

Finalized plans 

Budget 



Configuration, Testing 

Training, Deployment 

Evaluation 

Evaluation 

Evaluate: 

Use of the System, Implementation Process, Need 

for Enhancements, Return on Investment (ROI), 

Redirection of Employees 




then serve as a baseline or benchmark for system evaluation. Confirm that the 

return on investment is tangible as evidenced by improvements in care delivery, 

such as increased patient satisfaction measurements, increased workforce 

productivity, decreased patient wait times, or reduced medication errors. Monitor 

for unintended negative consequences of the implementation, and communicate 

both positive and negative consequences (Cantor, 2002). For example, look for 

possible evidence that the system might be contributing to an increase in 

medication errors or negatively impacting the delivery of quality care. Mitigate 

against any negative consequences by providing additional training to the users, 

holding the users accountable for best practice and correct use of the system. 

Finally, congratulate yourself and celebrate with the team for a job well done. 

System selection, development and implementation are not new phenomena, but it 

is an exciting opportunity to assist clinicians and patients and make a positive 

impact. It is paramount to document lessons learned and share with others who 

are embarking on the terrific adventure of automation of a healthcare system. 

References: 

Aucoin, B. & Kitzmiller, R. (2004, May) The nursing process: Addressing the challenges of the transition from paper to electronic documentation. 

Presented at the American Nursing Informatics Association 2004 Annual Conference. New Orleans, LA. 

Cantor, M. (2002). Software leadership: A guide to successful software development. New York: Addison-Wesley. 

Hampton Group. PMTalk. Enterprise project management: managing multiple projects, project fantasyland and some odd attitudes. 

Retrieved September 14, 2003, from http://www.rpm.com [Updated link: www.4pm.com/articles/pmtalk3-15-99.pdf] 

Hunt, E., Breckenridge-Sproat, S., Kitzmiller, R. (2004). The nursing informatics implementation guide. New York: Springer Verlag. 

Schwalbe, K. (2002). Information technology project management (2nd ed.). Boston: Course Technology. 

World Health Care Innovation and Technology 

Congress 

November 9 -11, 2005 * Washington DC 

The World Health Care Innovation and Technology Congress co-sponsored 

by The Wall Street Journal and CNBC, is a global forum to present 

best practices in the implementation of innovative business strategies, 

policy-making, and technology solutions to better our current health 

care system and improve the way you do business.Thought leaders and 

real-life case studies will demonstrate successful application of innovation 

in all its forms, and will provide insight to help resolve issues such as 

patient safety, clinical quality, access, and margins. 

The program will be practical, forward looking, sometimes controversial, 

and always thought provoking. It will provide specific, results-oriented 

education as well as collaborative, cross-constituency learning. Designed 

to attract an inclusive but carefully targeted and influential audience, the 

program will be managed so that each delegate will enjoy a high level of 

attention and resources, providing the most productive and immediately 

actionable experience possible. For more information please visit 

www.worldcongress.com. 

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