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System selection: sorting through the hype and hope (Part 2).

In the first part of this article, the author noted that a system selection process could be a daunting task without developing exclusion criteria. Exclusion criteria are systems characteristics that distinguish one Clinical Information S ystem (CIS) Vendor from another. Criteria identified in Part 1 include: HIPAA compliant, NIDSEC evaluation and certification, Clinical Documentation Limits and Autopopulation, Web Enabled Application, Server Types and Capacity, Sub-second response time, and System Scope. The remaining exclusion criteria helpful in sorting through the hype and hope of selecting the right CIS for your organization are described in this issue. (Ed.).

Physiological Monitoring: A common functional requirement is the capability to interface with a variety of physiological monitoring equipment. It is important to be knowledgeable about the types of devices your organization has and whether the physiological monitoring devices are networked versus stand-alone units.

First you need to conduct a baseline assessment of the types of physiological monitoring devices used in the critical care units or intermediate care units. Also include in the baseline assessment, patient care devices such as ventilators, IV infusion pumps, intra-aortic balloon pumps (IABP), thermal blankets, etc. The RFP should describe all the physiological monitoring devices by the name of manufacturer, device name and device identification number. This information in the RFP allows vendors to determine whether they have an interface written for a specific device. The goal is to eliminate those vendors that have minimal or no interfaces configured for the physiological monitoring equipment used by your organization.

Other aspects to consider in the baseline assessment of physiological monitoring include:

* Interviewing critical care nurses to assess which device makes sense to interface with the CIS. This is a good opportunity to determine the "must-have" and the "wants".

* Do a cost/benefit evaluation to determine whether it makes economic sense to interface the patient care devices or physiological monitor devices to the CIS.

* Determine how many devices will be interfaced with the clinical information system. A worse case scenario could include 4 devices per patient. A routine case would be 2 devices, as an example, BP (invasive, non-invasive) and EKG.

* Assess the type of network structure of the physiological monitoring system.

Physiological monitoring systems that are networked terminate at a black box called the systems communication controller device (SCC). You need to determine from the manufacturer whether the SCC uses proprietary communication protocols. This is important because connectivity needs to be established between the SCC and the CIS. This connectivity allows for signals coming out of the physiological monitoring systems to feed into the CIS. Proprietary communication protocols will require some kind of conversion to TCP/IP protocols. Stand-alone physiological monitoring equipment is not connected to a network topology. You may need to evaluate whether connectivity is required for the stand-alone equipment. Establishing connectivity with physiological monitoring equipment facilitates clinical effectiveness because clinicians do not have to manually enter patient parameters into the CIS.

Database Format and Structure: It is equally important to get data out of the CIS just as it is to get data into the CIS. The NIDSEC standards and scoring guidelines provide criteria to evaluate the database in the CIS. Specifically, the sections on clinical content associations and the clinical data repository. Other items to consider include;

* Determine if third party applications are needed to extract data and reformat the data for analysis. This is indicative of a proprietary database format and structure. You want a database that provides for easy retrieval and immediate data analysis.

* If your organization is planning to implement standard nursing languages in the CIS, a relational database is the optimal database structure to support the standard nursing languages (e.g., NIC, NOC and NANDA)

Network Architecture: There are several types of network topologies for CIS's. It is important to determine how the existing network in your organization can co-exist with the CIS. This is a good opportunity to collaborate with the Technical team in your organization to address some the following:

* Does your hospital have an existing local area network (LAN)? Or will the system have a separate LAN? Ask the vendor whether the CIS can co-exist with your organization's LAN or whether the CIS requires a separate LAN.

* Ask the vendor whether their CIS has Dynamic Internet Protocol (IP) addressing. Dynamic IP addressing is preferable because this allows clinicians to unplug network connections and plug to any network port in a patient care unit without having a specific address linked to a workstation. In other words, you do not want Static IP addressing.

* Ask the vendor to conduct a network survey in your hospital as part of the RFP vendor response. A network survey involves joint collaboration with a technical team and the clinical team. The network surveys include a walkthrough of the communication closets to assess network traffic, location and types of fiber connections. The survey also includes a walkthrough in the patient care area to evaluate workstation placement and utilization. The value of a network survey is for vendors to provide accurate cost information that represents your organization's infrastructure.

Videotape Vendor Demonstrations: CIS vendors have mixed reactions towards videotaping their demonstration. It is not common practice, but it is doable. A videotape of the system demonstration is useful in the certain circumstances. For example, clinicians may not able to make the demonstration. Clinicians may have questions after the demonstration and the videotape can help to clarify their questions. The videotape can also be included with the RFP response as another piece of information for contract negotiations. If the vendor refuses to have the demonstration videotaped, this should trigger a "red" flag reaction. To address the vendors apprehensions, you will need to do the following:

* Ask the vendor to prepare a confidentiality statement pertaining to videotaping the system demonstration.

* Review and sign the vendor's confidentiality statements pertaining to videotaping demonstrations. Your legal counsel may need to review this document before the final authority signs the document.

* Assure the vendor that the videotape will be returned after the system selection process.

In conclusion, applying exclusion criteria to your system selection is an effective strategy towards seeking the best vendors. This article describes examples of exclusion criteria for a CIS system selection process. In a system selection process, the consumer has the most leverage and should take every opportunity to ask the vendor for the best service and the best price. As consumer advocates, informatics nurses should strive for intellectual honesty about intellectual property.

By Liberty Rovira, MN, RN, BC
COPYRIGHT 2001 Capital Area Roundtable on Informatics in Nursing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2001 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Rovira, Liberty
Publication:CARING Newsletter
Geographic Code:1USA
Date:Sep 22, 2001
Previous Article:Top 10 reasons to write for the Caring Newsletter.
Next Article:President's message.

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