Nurse informaticians, leaders, and managers are involved in all stages of systems development and implementation. The systems development life cycle (SDLC) is a “standardized approach used to develop and implement information technology” (McBride & Tietze, 2016, p. 192). McGonigle & Mastrian (2017) compare the SDLC to the nursing process, where the nurses “assess, diagnose, plan, implement, evaluate, and revise” (p. 177). After the information system is selected and delivered, its life cycle or the SDLC begins. According to Elizabeth Murray (2017), the phases of the SDLC include “planning and analysis, design, implementation, and support and evaluation” (p. 197). The following work will examine the role of a graduate nurse (GN) in each phase of the SDLC.
The first distinct stage of the SDLC consists of the planning and the requirements definition. Interprofessional teams consisting of system analysts, software engineers, and nurse informaticians are concerned with the system’s development. During the planning stage, it is crucial to establish a plan covering the project goals and the so-called “scope of the project” (McBride & Tietze, 2016, p. 193). Additionally, the project should contain the requirements definition and the costs involved in the system implementation. Thus, the nurse informaticist should contribute to the planning phase by examining the needs of the end-users and defining requirements for the system’s successful implementation. During his/ her daily practice, the nurse might use questionnaires to assess and register the patients’ needs and requirements so that they would benefit the most from the new system. The team will then define the opportunities for improvement of the system and the finances required for the development based on the knowledge collected by the GN.
The second stage of the SDLC involves the analysis of the project requirements, processes, and workflows, to meet end-user expectations. The GN will work together with the team to develop data flow and process maps containing the information on the current state of the data and its future transformation and usage within the system (McBride & Tietze, 2016). The GN will also cooperate with the programmers and system analysts to review technical specifications during the system development. The nurse’s clinical experience and the knowledge of the healthcare provider’s patient population might help define the most effective tools and strategies for the project. Finally, the GN and the interdisciplinary team will prepare the report for the organization’s leadership containing the goals of the project and the results of the qualitative and quantitative analysis.
The third phase of the SDLC is dedicated to the design of the new system. End-user requirements analyzed in the previous phase should be applied during the design stage. At the high-level phase of design, the team will choose the programs and examine their interactions, while at the low-level phase, the functioning of the individual programs will be studied (McGonigle & Mastrian, 2017). Testing should be an integral part of the design stage, as it ensures the success of the new system. According to McBride and Tietze (2016), the goal of the testing is to “validate that the system works as intended, and to ensure that the components, features, devices, reports, screens, and user interfaces are ready for end-users” (p. 211). Thus, the GN will work with the project manager and systems analyst to design a functional programming code and software foundation for the future system. The GN will also participate in the testing of the hardware and software prototypes, evaluating their usability and conformity with the primary goals and requirements.
The fourth phase is system implementation, during which a system is presented to its users. The transmission from the paper-based form of documentation to the EHR may be a challenge for healthcare professionals as end-users of the system. Therefore, it is crucial to choose an approach appropriate for the specific clinical setting. There are three approaches to EHR implementation, including phased (incremental), big-bang, and parallel implementation approach. The phased approach involves the gradual implementation of new EHR in units and facilities, while the big-bang method requires immediate activation of EHR in all units. The parallel implementation approach supports the maintenance of the old system until all units of a healthcare system adopt the new system (McBride & Tietze, 2016). Thus, the GN and the nurse leader will be responsible for the selection of a proper approach to the implementation of EHR. After the approach is chosen, it is worth organizing the collaboration between data analysts and nurses to develop and analyze logs containing issues and end-user suggestions for improvement of the system. The practicing GN may also examine the feedback and prepare reports, which will help to improve the EHR.
The fifth stage of the SDLC involves the support, evaluation, and disposal of a system. According to Wager et al., 80% of financial resources are invested in maintenance and modification of the system (as cited in Murray, 2017, p. 197). The final stage requires an elaborate communication plan containing project details, stakeholders, strategy, events, and feedback. Additionally, the training plan should be made to prepare the employees for new procedures and workflow. The plans should be the result of the joint efforts of the executive management and the implementation team, including the GN. Moreover, the GN’s role is to review the feedback and logs received during the implementation stage and propose recommendations for the improvement of the EHR’s accessibility for users. Finally, Gladden (2016) suggests that the disposal of EHR is an essential stage of the SDLC, so decision-makers should “obtain the consent of individual users before changes are made to an eHealth ecosystem” (p. 871). Thus, the nurse leader and the GN will be responsible for securing the consent of patients whose data is kept in the system in case of its disposal.
Gladden, M. E. (2016). Managing the ethical dimensions of brain-computer interfaces in eHealth: An SDLC-based approach. In D. Vrontis, Y. Weber, & E. Tsoukatos (Eds.), Proceedings of the 9th Annual EuroMed Academy of Business conference: Innovation, entrepreneurship and digital ecosystems (pp. 889–902). EuroMed Press.
McBride, S. & Tietze, M. (2016). Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism. Springer.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Jones & Bartlett Learning.
Murray, E. (2017). Nursing leadership and management for patient safety and quality care. F. A. Davis Company.