Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
The following case scenario demonstrates the need to have all of the stakeholders involved from the beginning to the end of the systems development life cycle (SDLC). Creating the right team to manage the development is key. Various methodologies have been developed to guide this process. This chapter reviews the following approaches to SDLC: waterfall, rapid prototyping or rapid application development (RAD), object-oriented system development (OOSD), and dynamic system development method (DSDM). When reading about each approach, think about the case scenario and how important it is to understand the specific situational needs and the various methodologies for bringing a system to life. As in this case, it is generally necessary or beneficial to use a hybrid approach that blends two or more models for a robust development process. Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
As the case demonstrates, the process of developing systems or SDLC is an ongoing development with a life cycle. The first step in developing a system is to understand the problems or business needs. It is followed by understanding the solution or how to address those needs; developing a plan; implementing the plan; evaluating the implementation; and, finally, maintenance, review, and destruction. If the system needs major upgrading outside of the scope of the maintenance phase, if it needs to be replaced because of technological advances, or if the business needs change, a new project is launched, the old system is destroyed, and the life cycle begins anew. Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
SDLC is a way to deliver efficient and effective information systems (ISs) that fit with the strategic business plan of an organization. The business plan stems from the mission of the organization. In the world of health care, its development includes a needs assessment for the entire organization, which should include outreach linkages (as seen in the case scenario) and partnerships and merged or shared functions. The organization’s participating physicians and other ancillary professionals and their offices are included in thorough needs assessments. When developing a strategic plan, the design must take into account the existence of the organization within the larger healthcare delivery system and assess the various factors outside of the organization itself, including technological, legislative, and environmental issues that impact the organization. The plan must identify the needs of the organization as a whole and propose solutions to meet those needs or a way to address the issues. Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
Envision two large healthcare facilities that merge resources to better serve their community. This merger is called the Wellness Alliance, and its mission is to establish and manage community health programming that addresses the health needs of the rural, underserved populations in the area. The Wellness Alliance would like to establish pilot clinical sites in five rural areas to promote access and provide health care to these underserved consumers. Each clinical site will have a full-time program manager and three part-time employees (a secretary, a nurse, and a doctor). Each program manager will report to the wellness program coordinator, a newly created position within the Wellness Alliance.
Because you are a community health nurse with extensive experience, you have been appointed as the wellness program coordinator. Your directive is to establish these clinical sites within 3 months and report back in 6 months as to the following: (1) community health programs offered, (2) level of community involvement in outreach health programs and clinical site–based programming, (3) consumer visits made to the clinical site, and (4) personnel performance. Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
You are excited and challenged, but soon reality sets in: You know that you have five different sites with five different program managers. You need some way to gather the vital information from each of them in a similar manner so that the data are meaningful and useful to you as you develop your reports and evaluate the strengths and weaknesses of the pilot project. You know that you need a system that will handle all of the pilot project’s information needs.
Your first stop is the chief information officer of the health system, a nurse informaticist. You know her from the health management information system mini-seminar that she led. After explaining your needs, you share with her the constraint that this system must be in place in 3 months when the sites are up and running before you make your report. When she begins to ask questions, you realize that you do not know the answers. All you know is that you must be able to report on which community health programs were offered, track the level of community involvement in outreach health programs and clinical site–based programming, monitor consumer visits made to the clinical site, and monitor the performance of site personnel. You know that you want accessible, real-time tracking, but as far as programming and clinical site–related activities are concerned, you do not have a precise description of either the process or procedures that will be involved in implementing the pilot, or the means by which they will gather and enter data. Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
The chief information officer requires that you and each program manager remain involved in the development process. She assigns an information technology (IT) analyst to work with you and your team in the development of a system that will meet your current needs. After the first meeting, your head is spinning: The IT analyst has challenged your team not only to work out the process for your immediate needs, but also to envision what your needs will be in the future. At the next meeting, you tell the analyst that your team does not feel comfortable trying to map everything out at this point. He states that there are several ways to go about building the system and software by using the SDLC. Noticing the blank look on everyone’s faces, he explains that the SDLC is a series of actions used to develop an IS. The SDLC is similar to the nursing process, in which the nurse must assess, diagnose, plan, implement, evaluate, and revise. If the plan developed in this way does not meet the patient’s need or if a new problem arises, the nurse either revises and updates the plan or starts anew. Likewise, you will plan, analyze, design, implement, operate, support, and secure the proposed community health system. Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
The SDLC is an iterative process—a conceptual model that is used in project management describing the phases involved in building or developing an IS. It moves from assessing feasibility or project initiation, to design analysis, to system specification, to programming, to testing, to implementation, to maintenance, and to destruction—literally from beginning to end. As the IT analyst describes this process, once again he sees puzzled looks. He quickly states that even the destruction of the system is planned—that is, how it will be retired, broken down, and replaced with a new system. Even during upgrades, destruction tactics can be invoked to secure the data and even decide if servers are to be disposed of or repurposed. The security people will tell you that this is their phase, where they make sure that any sensitive information is properly handled and decide whether the data are to be securely and safely archived or destroyed.
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After reviewing all of the possible methods and helping you to conduct your feasibility and business study, the analyst chooses the DSDM. This SDLC model was chosen because it works well when the time span is short and the requirements are fluctuating and mainly unknown at the outset. The IT analyst explains that this model works well on tight schedules and is a highly iterative and incremental approach that stresses continuous user input and involvement. As part of this highly iterative process, the team will revisit and loop through the same development activities numerous times; this repetitive examination provides ever-increasing levels of detail, thereby improving accuracy. The analyst explains that you will use a mockup of the hospital information system (HIS) and design for what is known; you will then create your own mini-system that will interface with the HIS. Because time is short, the analysis, design, and development phases will occur simultaneously while you are formulating and revising your specific requirements through the iterative process so that they can be integrated into the system. Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
The functional model iteration phase will be completed in 2 weeks based on the information that you have given to the analyst. At that time, the prototype will be reviewed by the team. The IT analyst tells you to expect at least two or more iterations of the prototype based on your input. You should end with software that provides some key capabilities. Design and testing will occur in the design and build iteration phase and continue until the system is ready for implementation, the final phase. This DSDM should work well because any previous phase can be revisited and reworked through its iterative process.
One month into the SDLC process, the IT analyst tells the team that he will be leaving his position at Wellness Alliance. He introduces his replacement. She is new to Wellness Alliance and is eager to work with the team. The initial IT analyst will be there 1 more week to help the new analyst with the transition. When he explains that you are working through DSDM, she looks a bit panicky and states that she has never used this approach. She has used the waterfall, prototyping, iterative enhancement, spiral, and object-oriented methodologies—but never the DSDM. From what she heard, DSDM is new and often runs amok because of the lack of understanding as to how to implement it appropriately. After 1 week on the project, the new IT analyst believes that this approach was not the best choice. As the leader of this SDLC, she is growing concerned about having a product ready at the point when the clinical sites open. She might combine another method to create a hybrid approach with which she would be more comfortable; she is thinking out loud and has everyone very nervous. Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
The IT analyst reviews the equipment that has arrived for the sites and is excited to learn that the computers were ordered from Apple. They will be powerful and versatile enough for your needs.
Two months after the opening of the clinical sites, you, as the wellness program coordinator are still tweaking the system with the help of the IT analyst. It is hard to believe how quickly the team was able to get a robust system in place. As you think back on the process, it seems so long ago that you reviewed the HIS for deficiencies and screen shots. You reexamined your requirements and watched them come to life through five prototype iterations and constant security updates. You trained your personnel on its use, tested its performance, and made final adjustments before implementation. Your own stand-alone system that met your needs was installed and fully operational on the Friday before you opened the clinic doors on Monday, 1 day ahead of schedule. You are continuing to evaluate and modify the system, but that is how the SDLC works: It is never finished, but rather constantly evolving. Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
SDLC can occur within an organization, be outsourced, or be a blend of the two approaches. With outsourcing, the team hires an outside organization to carry out all or some of the development. Developing systems that truly meet business needs is not an easy task and is quite complex. Therefore, it is common to run over budget and miss milestones. When reading this chapter, reflect on the case scenario and in general the challenges teams face when developing systems Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making
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