Running head: PRACTICUM EXPERIENCE

Practicum Experience: The Work of an Application Systems Analyst Katie J. Tiesworth Ferris State University

PRACTICUM EXPERIENCE Abstract The purpose of this writing will be to describe the issues, concerns, and challenges faced by an

application systems analyst as applicable to four of the standards of nursing informatics practice: (a) assessment, (b) problem and issue identification, (c) outcome identification, and (d) planning (ANA, 2008). In relation, strategies will be described which were utilized to overcome these issues, concerns, and challenges. Additionally, applicable literature, research, and theory which could be utilized will be described. Last, a description of the project utilized for this practicum experience will be discussed.

PRACTICUM EXPERIENCE Practicum Experience: The Work of an Application Systems Analyst With a strong clinical background and understanding of nursing science, computer science, and information science, nurses today have the ability to play an integral role in the

design and development of information technology in healthcare (Saba & McCormick, 2011). In relation, there are multiple roles which a nurse could play in the realm of information systems, including the role of analyst (McGonigle & Mastrain, 2009). Throughout this last semester, I had the privilege to complete a 300 hour practicum experience at Spectrum Health in hopes of better understanding this role. With the help of my preceptor, not only was an understanding of this role gained, but also an understanding of the issues, concerns, and challenges this role may face. The purpose of this writing will be to describe these issues, concerns, and challenges as they apply to the standards of nursing informatics practice. In addition, strategies applied to address these issues will be discussed along with research and theory which may be applied. Following this, the project which I took part in as part of my practicum experience will be described. Identification of and Strategies Applied to Address Issues, Concerns, and Challenges Related to the Analyst Role Throughout the semester, this practicum experience has allowed me the ability to participate in a variety of different activities. Along with being able to participate in the Care Compass project, which will be described in more depth below, I was also able to participate in a variety of different work groups whose focus ranged from project initiation to improving systems which had been previously implemented. In addition to these activities, I had the privilege to work alongside my preceptor during some of her every day activities to understand her position and the work of an analyst more thoroughly.

PRACTICUM EXPERIENCE While taking part in the above described experiences, I not only gained a better understanding of the work of an application systems analyst, but also gained a better understanding of the issues, concerns, and challenges which an application systems analyst may

encounter. Below I will describe some of these issues, concerns, and challenges as they apply to four of the standards of nursing informatics practice: (a) assessment, (b) problem and issue identification, (c) outcomes identification, and (d) planning (ANA, 2008). Additionally, strategies applied to resolve the identified issues, concerns, and challenges as well as related research and theory will be discussed. Assessment The standard of assessment includes collecting data, information, and knowledge pertinent to the situation. When collecting the appropriate data, key stakeholders should be included and the information should be recorded in an appropriate fashion (ANA, 2008). According to Saba & McCormick (2011), the nursing informatics standard of assessment strongly correlates with the initiation phase of the systems development life cycle as well as the initiation phase of project management, both of which can be utilized when implementing a new clinical system or functionality. Throughout my practicum work, there were multiple situations in which these processes or components of these processes were utilized to assist in avoiding issues or overcoming challenges. As related to the standard of assessment, the challenges of appropriate stakeholder involvement and maintaining project clarity will be discussed. Stakeholder Involvement One challenge noted throughout this practicum experience was that of ensuring the appropriate persons are involved in a project or request from the beginning, hopefully increasing the likelihood the appropriate decisions will be made. It became apparent that when the

PRACTICUM EXPERIENCE appropriate assessment work is not completed on the front end, there is a chance of having to complete rework further into the project. According to Saba and McCormick (2011), one of the first and most crucial steps to an implementation includes a review and analysis of the current work flow and processes. When defining this current state, it is best to ensure that those areas affected are represented and it is best if those involved are current end users of the system and process in question (Houston & Bove, 2007). Though I did not come across this directly, there were times during my practicum in which my preceptor was able to point out when projects may have been more successful if certain stakeholders would have been involved who were not. While working to change documentation or the build of the electronic health record (EHR), there are multiple stakeholder groups who should be involved. Along with those identified as content experts, end users of the

system or documentation in question should also be involved as they would be best able to speak to the workflow (M. Poulias, personal communication, June 3, 2013). These key stakeholders should not only be thought of as the primary users of the system, but should be considered the primary drivers of the project. When appropriate, those end users involved should include the full spectrum of clinical staff, administrative staff, financial staff, and any other persons who rely on the EHR to carry out their daily responsibilities. Additional stakeholders who must be considered include risk, quality, and infection control (Amatayakul, 2007). When working on a new EHR design, those stakeholders involved should work on the design in conjunction with one another, rather than in independent groups. Working in independent groups, or silos, may create competing design decisions which will make agreement on a final design more difficult (M. Poulias, personal communication, July 22, 2013). In addition, bringing all major stakeholders together allows for open discussion (Houston & Bove,

PRACTICUM EXPERIENCE 2007). Though some groups may feel the need to work separately from other clinicians, healthcare in nature is a team process and these interactive processes need to be addressed (Amatayakul, 2007). It should be kept in mind, however, that those who are not considered major stakeholders may find some meetings to be a waste of time. When first bringing stakeholders into a project, the role which they will play should be clearly defined (Houston & Bove, 2007). Project Clarity As pertaining to the standard of assessment and the Care Compass project, an identified challenge revolved around confusion amongst those involved in the project as to what all would be involved with the project pilot. As discussions around the pilot began, it was apparent there may be confusion around which user positions would be involved. While some members of the group thought the pilot would only pertain to the nurses identified on the chosen pilot units, others considered all users who may interact with patients on the identified units as participants

in the pilot. While a final decision was made that only those nurses from the chosen units would participate, it was important to communicate this clearly as a group to ensure understanding. To help reduce confusion amongst the members of the group and to come to consensus, the project team worked together to finalize a project charter which outlined what would be and what would not be in scope for not only the project pilot, but the project as a whole. According to the Project Management Institute (2008), with each new project, a project charter should be completed. In fact, this project charter should be completed as one of the first steps of a new project. As part of such a charter, the project (a) purpose, (b) description, (c) goals and objectives, (d) scope, (e) assumptions, (f) constraints, (g) membership, (h) commitments and responsibilities, and (i) deliverables should all be included (Saba & McCormick, 2011). Once

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this document is completed, any changes to the document need to be approved by the appropriate persons and these persons should be identified within the document itself. Such precautions would help to avoid scope creep (Houston & Bove, 2007). Problem and Issue Identification Problem and issue identification includes analyzing assessment data to determine if there are problems or issues. Those problems or issues identified should be validated with key stakeholders (ANA, 2008). When assessing a new system to be implemented or new functionality, both a gap analysis and a risk analysis should be performed. A gap analysis entails comparing the current work flow and tools to the future work flow and tools. By doing this, any gaps in the future work flow and tools can be identified (Saba & McCormick, 2011). Below, two identified challenges related to problem and issue identification, appropriate testing and change management, will be discussed. Appropriate Testing Throughout this practicum experience, there were multiple situations in which the standard of problem and issue identification should be utilized, but the one current initiative in which this became most apparent is that of the upcoming upgrade to the EHR. With the upcoming upgrade, there are a multitude of changes which will be occurring to the system. Some of these changes will be obvious to the end user while others will not. Ensuring all of the applicable changes and issues are identified can be challenging. When making any changes to the EHR, an in depth analysis should be completed. With the new code and upgrade being applied to the system, thorough testing is taking place by both analysts and clinical staff to ensure that all changes, along with potential issues, are identified. According to Sayles and Trawick (2010), testing is an integral part of any EHR implementation

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and should be performed in a cyclical fashion. By this, once issues are identified, they should be fixed, then testing should begin again. When performing the testing, testing scripts should be utilized and any issues found should be tracked (Saba & McCormick, 2011). Any identified issues should be corrected prior to implementation (Trawick & Sayles, 2010). In addition, while completing this testing, further analysis is being completed to analyze to what degree the end users will be affected by the changes. This analysis will dictate how much education will be required. Change Management Another challenge which was encountered during my practicum experience was that of knowing the appropriate ways to handle change management. With the Care Compass project, it was noted by leadership that nurses may resist the change from the Patient Access List (PAL) to Care Compass, as the change would be viewed as one which is unnecessary. Along with this, as the nurses use the PAL as an integral part of their current workflow, it is thought that the nurses may have formed a type of bond with this product which may be difficult to break. To help facilitate this change, the team working on the Care Compass project discussed what delivery method might be best for education. It was discussed that not only should the nurses understand the functionality of the system, but should also understand how the new functionality will most benefit them. When implementing a new system, as part of the Technology Acceptance Model, a users perceived ease of use of the system as well as their perceived usefulness of the system both directly predict whether the system will be successful (Holden & Karsh, 2011). Perceived ease of use can be defined as the degree to which a person believes a system to be effortless (Tung, Chang, & Chou, 2007, p. 5). Perceived usefulness can be defined as the degree to which a person believes a particular system will enhance his or her

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job (Tung, Chang, & Chou, 2007, p. 5). By ensuring the users have a good understanding of the functionality, as well as ensuring they understand how the new functionality will benefit their workflow, the implementation of Care Compass may be more successful. In addition, as part of Rogers Innovation Diffusion Theory, it has been shown that relative advantage, compatibility, and complexity consistently relate to innovation adoption. Relative advantage is the degree to which users see benefit from using this innovation over another. Compatibility is the extent to which users needs are met by the functionality. Last, complexity is the level of difficulty users have understanding and using the system. From these descriptions, it can be seen how Rogers Innovation Diffusion Theory reflects the Technology Acceptance model (Tung, Chang, & Chou, 2007). When relating this theory to the Care Compass project, it can again be predicted that ensuring users understand both the functionality as well as the possible benefits of the system will help to ensure the system is well adopted. Outcomes Identification The standard of outcomes identification includes identifying expected outcomes while considering the risks, benefits, costs, environmental factors, and expertise associated. The outcomes defined should maximize quality and efficiency while integrating evidence and clinical guidelines into the information system, thus into practice (ANA, 2008). According to Saba and McCormick (2011), an analyst will work to identify potential solutions to an issue and will then assist to decide which solution is best. This is a challenge which my preceptor took on regularly. A large part of her position involves designing EHR solutions which will not only meet the intended need but that will also be efficient and easy to use. Below, an identified challenge related to outcomes identification will be discussed, solution identification.

PRACTICUM EXPERIENCE Solution Identification

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One of my first experiences during my practicum work was the ability to participate in a Rapids Improvement Event (RIE). This RIE focused on issues being had at a community hospital which was recently brought live on the EHR. Since the go live, multiple issues had been identified within the system by the community hospital leadership and it was felt that an RIE would be the correct forum to bring the appropriate persons together to try to resolve these issues. The problems and issues had already previously been identified prior to this event and the purpose of the event was to collaboratively work to find solutions to these problems. The challenge from the perspective of the analyst was to not only find effective solutions, but to also ensure the solutions would not negatively affect any of the other sites using this same system. Prior to attending the RIE session described above, work was done with my preceptor to analyze the list of issues which was passed along from the leadership of the recently added community hospital. From this issues list, my preceptor was able to investigate solutions prior to the event to make the event more efficient. In addition to considering solutions which are technology based, work flow solutions were also considered. While attending the RIE, it was important to also educate those who were requesting the changes as to what is and what is not possible from within the EHR (M. Poulias, personal communication, May 27, 2013). By performing education, it helped to focus the users on strategies which were possible. Throughout my practicum experience I also had the ability to participate in various small work groups in which my preceptor was called upon to help design a solution for a specific need. Example issues which were trying to be resolved by these work groups included (a) attempting to make the work of the patient placement department more efficient by streamlining the information needed within the EHR, (b) identification of an appropriate workflow around

PRACTICUM EXPERIENCE automatic printing of physician progress notes, and (c) the need for additional documentation fields needed by the interventional radiology department and how best to incorporate these

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fields. The common challenge faced while participating within any of these groups was that of ensuring an appropriate EHR design which would both meet the needs of the end user as well as ensure efficiency. While working through my practicum experience, there were multiple strategies which were used to help ensure the design of the EHR meets the needs of the end user while being efficient and user friendly. One strategy expressed to me by my preceptor was that of keeping the EHR consistent. Not only should the varying screens one user sees be consistent, but views between varying types of users should also be consistent. Along with this, user efficiencies can be improved by ensuring that users do not have to click into unnecessary screens or scroll when not necessary (M. Poulias, personal communication, June 24, 2013). Under the concepts of cognitive ergonomics, when designing an EHR, the system should be able to provide an intuitive, consistent, and uncluttered user interface. Along with this, the EHR should allow the user to maintain situational awareness by keeping information clear, distinct, and easily accessible (Lawler, Hedge, & Pavlovic-Veselinovic, 2011). When designing the EHR, the design should be continuously evaluated for usability. Usability indicators include (a) ease of use, (b) ease of learning, (c) satisfaction with using, (d) efficiency of use, (e) error tolerance, and (f) fit of the system to the task. Approaches which can be taken to test usability could include (a) surveying potential users, (b) focus groups, or (c) a cognitive walk through, amongst other options (McGonigle & Mastrain, 2009). Along with this, users should have access to a quick, consistent, and responsive way to provide communication

PRACTICUM EXPERIENCE pertaining to system flaws, as well as a means of receiving feedback on the appropriate way to use the system (Lawler, Hedge, & Pavlovic-Veselinovic, 2011). Planning

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Planning involves developing a plan of strategies, alternatives, and recommendations to attain identified outcomes. As part of this plan, an implementation pathway and timeline should be documented as to when the identified outcomes may be met. The plan should reflect regulations and quality standards while considering the clinical, financial, and social impact (ANA, 2008). At this point in an implementation, the type of education to be administered should be chosen and those who will be in charge of creating and administering the education should be identified. In addition, if the implementation will benefit from the use of super users, those who will take on this role should also be named (Saba & McCormick, 2011). Below, two challenges related to planning will be discussed, work prioritization and timeline creation. Work Prioritization One challenge related to this standard which became apparent throughout my practicum work was the need for work prioritization. With the abundant amount of competing requests being submitted by users and leadership throughout the system, it is difficult as an analyst, or as an organization, to know which request to carry out and complete first. This has become increasingly more difficult as the need to complete initiatives around Meaningful Use and ICD 10 have taken precedence over lower priority initiatives (M. Poulias, personal communication, July 29, 2013). As an organization, Spectrum Health has worked to improve its system for work and request prioritization. In relation to the Six Sigma concept, a set of true north metrics have been utilized as performance indicators to assist in this prioritization work. As defined by Saba &

PRACTICUM EXPERIENCE McCormick (2011), Six Sigma works to improve organizations processes while reducing the

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amount of variation. When a new request is placed, each is to be rated in terms of (a) safety and quality, (b) financial stewardship, (c) growth, (d) patient experience, and (e) morale and engagement. These ratings are then used to assist in deciding which work efforts should take place first. Timeline Identification An additional issue encountered as pertaining to the standard of planning revolved around the creation of a time line concerning the care compass project. In order to implement Care Compass to the pilot group, a series of events needed to take place first. Prior to implementation taking place, education would need to be created. In order for the education to be created, the build of the care compass would need to be completed in an environment or domain in which the educators could utilize. The issue arose when trying to complete the build of care compass within this planned domain. Once the build began, it became apparent that there were issues within the Care Compass product which needed to be fixed. Due to these issues, the remaining timeline of the Care Compass project was delayed. As part of the planning phase of any project, a work plan should be created. This work plan should include a list of all necessary activities needed to complete the project, the estimated duration of each of these activities with beginning and end dates, and any interdependencies the documented activities have with one another. As the project moves forward, the work plan should outline which activities have been completed and which ones are in progress (Houston & Bove, 2007). Pertaining to the Care Compass project, by knowing early in the project which activities were interdependent of each other, it was easy to know the downstream effects the build issues would have. Having the knowledge these issues would directly affect the ability to

PRACTICUM EXPERIENCE create education materials, the project team was able to communicate to the department managers the need to push back the education dates. Description and Analysis of Clinical Project Going into this practicum experience, my hope for my clinical project was to be able to focus on the upcoming implementation of the electronic plans of care at Spectrum Health.

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However, as my practicum hours began, it became apparent there would be a delay in initiating the plans of care, meaning I would not be able to participate in any activities surrounding this project during the semester. In light of this, I was able to work with my preceptor to find another project which could fit the needs of this practicum experience. After evaluating varying initiatives occurring at Spectrum Health, it was decided that participating in the Care Compass project would be the most beneficial and best fit. While this transition was last minute, the change from one project focus to another was quite smooth as many of the same implementation concepts which could be applied to the electronic plans of care could also be applied to the Care Compass project. As described by Cerner (2013), Care Compass is an interdisciplinary summary workflow solution which helps to organize, prioritize, and plan patient care. It is intended that Care Compass will have the ability to provide the clinician with 90% of the information which is needed to care for their patient, face up, as soon as they enter into the EHR. Along with this, Care Compass will provide quick easy links to the most important parts of the chart (Cerner, 2013). Currently at Spectrum Health, all inpatient areas are using a similar product, the PAL. Nurses today rely on the PAL to help organize their tasks and care for their patients. Due to the PAL no longer being supported by the EHR vendor after the end of 2014, it is necessary to switch from the use of the PAL to Care Compass.

PRACTICUM EXPERIENCE Build Completion

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When first participating in the Care Compass project, much of the build had already been completed. However, there were still some issues with the current functionality which would need to be reconciled before moving forward with the project. As mentioned previously, any issues with the functionality should be identified and corrected prior to implementation (Trawick & Sayles, 2010). One example of functionality which needed attention was that of how to alert a nurse when orders had been entered into the EHR by another nurse. Further work and research would need to be completed to know if there was a way to fix this issue. If there was not a fix, then work flows would need to be looked at to know how to accommodate this. In anticipating a need for a solution, research was completed as to possible build options for Care Compass as well as possible work flows around this process which are used at other facilities. This research was shared with the analyst who has been tasked with the main build of Care Compass. Project Charter Creation As the build for this project was moving further towards completion, the project team then needed to begin making decisions on how the project would be implemented. To begin this decision making process, and to also ensure that everyone was on the same page, the project team worked to create a project charter which outlined the goals and expectations of both the project pilot and the project as a whole. According to Saba & McCormick (2011), one of the first steps of any project should include the finalization of a project charter. Though the process of putting together the charter was tedious, the final product was extremely helpful in clarifying what the expectations of the project group were and what the final project product would look like. Working through the project charter also stimulated conversation amongst the group

PRACTICUM EXPERIENCE members which helped bring to light some misconceptions of what was to be involved in both the pilot, as well as the larger project as a whole. Education Planning

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With the project charter finalized and the build mostly completed, the group was able to move on to education planning. The first questions which were to be answered by the group included what type of educational format would work best, as well as how much education would be needed. The various educational formats available to choose from included (a) classroom, (b) online simulation, or (c) flyer. It was easily agreed on by the group that an educational flyer would not be sufficient as the change in work flow would be too great to be fully understood and appreciated in a flyer format alone. With the last two options, it was felt that an online simulation may be sufficient to educate to the new functionality, however may not sufficiently allow the nurses to truly understand how they may benefit from the new functionality. In relation, not understanding the possible benefits of the new system could impact the ease of adoption amongst users (Tung, Chang, & Chou, 2007). Last, it was felt that the nurses may see the most benefit from attending a classroom style education; however, it may be difficult to arrange for all nurses to attend class for the amount of time necessary. With the above educational options discussed, it was suggested that a hybrid method be utilized. In order for the nurses to be exposed to and begin understanding the functionality, an online simulation module would be assigned which would take the nurses approximately twenty minutes to complete. The nurses would then be asked to participate in open class room session where they would be given a paper scenario to complete within the training environment. It was felt that with this type of model, the nurses may be able to first grasp the functionality of Care Compass, and then more fully understand the benefits of Care Compass with the hands on time.

PRACTICUM EXPERIENCE With this project, this functionality is to be first rolled out to pilot units throughout the

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Spectrum Health system. The above educational model was presented to the leadership of these four pilot units. From this, it was determined that each unit felt they could manage a variation of this model. These variations included: (a) requiring all users on the unit to complete both the online simulation as well as attend the open class room session, (b) requiring all users to complete the online simulation while only the super users would attend the open class room session, (c) requiring all users to complete the online simulation only, and (d) requiring users to complete a more thorough open class room session. While it was noted that there would be four different educational strategies implemented, this may pose as beneficial once the group is able to assess which educational model was the most successful. This determination could help drive the implementation to all of the remaining units. Work Plan Creation With the education plan for the pilot units in place, it was then necessary to formulate a timeline for when education should be completed, as well as for when the pilot units should go live with the new functionality. While creating this timeline, there were also other components which needed to be considered and kept in mind. In order for the education to be created, the final build would need to be completed in one of the testing environments so that it could then be copied over into the training environment. While the work of building the online simulation could begin once the build in the testing environment was completed, the open class room sessions would not be able to begin until the copy from the testing environment to the training environment was complete. In addition to this, the area in which the nurses complete their online simulations will also be going through an upgrade in the near future which will bring this system

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offline for approximately one week. This time line would also had to be considered and worked around. Project Barriers As described above, the build of the Care Compass had to first be completed in the testing environment. While completing this build, it was discovered that there were some issues with the system which were causing Care Compass to not load properly. This issue ultimately had to be sent on to the EHR vendor for resolution. While the issue was eventually resolved, it caused a delay which affected the remaining timeline. Moving forward, as the build was completed in the testing environment; an additional system issue was discovered. This particular issue revolved around the firing of alerts to the nurse on the Care Compass. It was noted that if a nurse documented in a particular fashion, it may cause some alerts to not fire appropriately. Discussion occurred on how to best resolve this issue. Options for resolution included (a) turn off the affected alert, (b) educate staff to the discrepancies created, or (c) look to change the documentation which was causing the issue. While the group originally leaned towards the option of changing the documentation, upon further analysis it was discovered that changing the documentation could have many negative downstream effects. With this insight, the group then decided that turning off the particular alert would be the best choice. It was felt that though nurses may need to click further into the chart to find this particular information, it was better to have a consistent process rather than varying processes which could cause confusion. Evaluation of Practicum An evaluation form has been completed by both me (Appendix A) and my preceptor (Appendix B) in order to evaluate my performance throughout this semester. The evaluation

PRACTICUM EXPERIENCE form looked to evaluate my ability to use four of the standards of nursing informatics practice:

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(a) assessment, (b) problem and issue identification, (c) outcomes identification, and (d) planning (ANA, 2008). For each of these standards, my ability to (a) engage in continuous self-evaluation and self-directed learning, (b) demonstrate an understanding of its role and importance, and (c) incorporate evidence based assessment techniques into practice were to be evaluated. According to the ANA (2008), the informatics nurse should evaluate ones own nursing and informatics practice on a regular basis to identify both strengths and areas for further development. Along with this, the informatics nurse should seek this same feedback from peers, colleagues, and other key stakeholders (ANA, 2008). Participating in this evaluation process allows for both self-evaluations as well evaluation from another. The next steps from this evaluation process should include identification of goals for self-improvement (ANA, 2008). From this, it will be important to evaluate my completed self-evaluation along with the evaluation completed by my preceptor to begin setting goals for how to grow in my career. Conclusion In conclusion, this practicum experience has allowed me to not only better understand the work of an application systems analyst, but to gain insight into the issues, concerns, and challenges which an analyst may encounter. In addition, working with my preceptor has allowed me to more fully understand the strategies which may be used by an analyst to overcome these issues, concerns, and challenges, as well as research and theory which may be called upon to assist in these situations. Though much knowledge was gained throughout this experience, I understand there is still much to learn. As this semester comes to an end, I look forward to setting goals to continue to grow in my career.

PRACTICUM EXPERIENCE References Amatayakul, M. K. (2007). Electronic health records: A practical guide for professionals and organizations. Chicago, IL: American Health Information Management Association. American Nurses Association. (2008). Nursing informatics: Scope and standards of practice. Washingtion, D.C.: Nursebooks.org. Cerner. (2013). Overview of care compass. Retrieved from Cerner.com. Holden, R. J., & Karsh, B. T. (2010). The technology acceptance model: Its part and its future in healthcare. NIH Public Access, 43(10). Retrieved from www.clinicalkey.com Houston, S. M., & Bove, L. A. (2007). Project management for healthcare informatics. New York, NY: Springer Science and Business Media, LLC. Lawler, E. K., Hedge, A., & Pavlovic-Veselinovic, S. (2011). Cognitive ergonomics, sociotechnical systems, and the impact of healthcare information technologies. International Journal of Industrial Ergonomics, 41(4). McGonigle, D., & Mastrain, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett Publishers. Project Management Institute. (2008). A guide to the project management body of knowledge: PMBOK guide. Newtown Square, PA: Project Management Institute. Saba, V. K., & McCormick, K. A. (2011). Essentials of nursing informatics. United States of America: McGraw Hill Companies, Inc.

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Sayles, N. B., & Trawick, K. C. (2010). Introduction to computer systems for health information technology. Chicago, IL: American Health Information Management Association Press. Tung, F. C., Chang, S. C., & Chou, C. M. (2007). An extension of trust and TAM model with IDT in the adoption of the electronic logistics information system in HIS in the medical

PRACTICUM EXPERIENCE industry. International Journal of Medical Informatics, 77(5). Retrieved from www.clincalkey.com.

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PRACTICUM EXPERIENCE Appendix A

0 Undocumented Competencies Not applicable or not observed 1 Minimal (Unacceptable) Inability to meet expectation level or limited or inconsistent demonstration of competence 2 Basic (Unacceptable) Somewhat limited or inconsistent performance of competence 3 Proficient (Acceptable) Complete demonstration at level expected for person entering the field

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4 Advanced (Target) Complete and outstanding competence; exceeds target expectations for those entering the field

Assessment
Engages in continuous self-evaluation and self-directed learning. Demonstrates an understanding of the role and importance of the assessment process Incorporates evidenced based assessment techniques into practice 0 1 2 3 4 0 1 2 3 4

Problem and Issue Identification

Engages in continuous self-evaluation and self-directed learning. Demonstrates an understanding of the role and importance of the problem and issues identification process Incorporates evidenced based techniques when identifying and documenting problems and issues 0 1 2 3 4

Outcomes Identification
Engages in continuous self-evaluation and self-directed learning. 0 1 2 3 4

PRACTICUM EXPERIENCE
0 Undocumented Demonstrates an understanding of the role and importance of the outcomes identification process Incorporates evidenced based techniques when identifying and documenting potential outcomes 1 Minimal (Unacceptable) 2 Basic (Unacceptable) 3 Proficient (Acceptable)

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4 Advanced (Target)

Planning
Engages in continuous self-evaluation and self-directed learning. Demonstrates an understanding of the role and importance of the planning process Incorporates evidenced based techniques when identifying and documenting potential plans 0 1 2 3 4

Comments: I believe that throughout this semester, I was able to self-evaluate when participating in activities to know when I needed to further expand my knowledge on a subject. Not only was I able to seek clarification from my preceptor but was also able to independently study the subject at hand. While my understanding of these standards of nursing informatics practice has grown, I know there will always be more to learn. Similarly, though my knowledge of related evidenced based techniques has also grown, again I know there will always be room to expand my knowledge further.

PRACTICUM EXPERIENCE Appendix B

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GRADING RUBRIC FOR CLINICAL PRACTICUM PAPER Below Expectations

A. Introduction (2 points) The introduction is below average. It is not clear what will be discussed. B. Issues, concerns, & challenges related to application of this role (12 points) There is a below average analysis of the issues, concerns, & challenges related to the students application of the role. This analysis is not supported well by the literature. The analysis is lacking in depth & breadth (12 points) There is a below average analysis of the strategies and approaches that were applied to address the issues, challenges, & concerns. This analysis lacks depth &

Needs Improvement
(3 points) There is an average, brief introduction to the paper and what will be discussed (15 points) There is an average analysis of the issues, concerns, & challenges related to the students application of the role support by the literature. This analysis could use more depth & breadth

Meets Expectations
(4 points) There is a good, clear, brief introduction to the paper and what will be discussed (17 points) There is a good analysis of the issues, concerns, & challenges related to the students application of the role support by the literature. This analysis has good depth & breadth.

Excep

(5 points

There is introduc be discu

(20 poin

There is issues, to the st support has exc

C. Strategies and approaches that were applied to address the issues,

(15 points) There is an average analysis of the strategies and approaches that were applied to address the issues, challenges, & concerns. This analysis could use more depth &

(17 points) There is a good analysis of the strategies and approaches that were applied to address the issues, challenges, & concerns supported by the literature. This analysis has

(20 poin

There is strategie applied challeng the litera

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challenges, & concerns breadth, does not have adequate literature to support it, and does not effectively address both ethical decision-making and effective problem solving. (12 points) There is a below average demonstration of the application of knowledge from practice, theory, and research. The analysis lacks depth & breadth. Two or more of these areas are not effectively addressed. (8 points) There is a below average description and analysis of the clinical project that demonstrates direct application of the role. This analysis lacks depth & breadth. breadth, may not be adequately supported by the literature, and may not have effectively addressed both ethical decision-making and effective problem solving. (15 points) There is an average demonstration of the application of knowledge from practice, theory, and research. The analysis could use more depth & breadth. One of these areas is not effectively addressed. (11 points) There is an average description and analysis of the clinical project that demonstrates direct application of the role. This analysis could use more depth & breadth.

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good depth & breadth but may not have effectively address both ethical decision-making and effective problem solving.

excellen ethical d problem

D. Application of knowledge from practice, theory, and research

(17 points) There is good demonstration of the application of knowledge from practice, theory, and research. One of these areas may be addressed in less depth & breadth.

(20 poin

There is the appl practice

E. Description & analysis of clinical project

(13 points) There is a good description and analysis of the clinical project that demonstrates direct application of the role. This analysis has good depth & breadth.

(15 poin

There is analysis demons role. Th & bread

F. Evaluation of Practicum

(5 points) There is a below average evaluation of the practicum. More than two surveys that includes both the preceptors and students evaluations of the individualized objectives, and other evaluations as appropriate (students, staff, etc.) are missing.

(7 points) There is an average evaluation of the practicum that includes both the preceptors and students evaluations of the individualized objectives, and other evaluations as appropriate (students, staff, etc.). Two key surveys may be missing.

(8 points) There is a good evaluation of the practicum that includes both the preceptors and students evaluations of the individualized objectives, and other evaluations as appropriate (students, staff, etc.). One key survey may be missing.

(10 poin

There is practicu precepto the indiv evaluati staff, etc

G. Conclusion

(2 points) There is a below average summary or conclusion related to the key points in the paper. All new information is introduced.

(3 points) There is an average summary or conclusion related to the key points in the paper. Mostly new information is introduced. (3 points) Resources are mostly current (< 5yrs. unless a classical resource) with a minimum of 8 which are evidence-based.

(4 points) There is a good summary or conclusion related to the key points in the paper. Some new information may be introduced. (4 points) Resources are mostly current (< 5yrs. unless a classical resource) with a minimum of 9 which are evidence-based.

(5 points

There is conclus the pape introduc

H. Data & Information

( 2 points) Resources are somewhat current (< 5yrs. unless a classical resource) with a minimum of 7 which are evidence-based.

(5 points

Resourc classica 10 whic

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TOTAL POINTS FOR CONTENT:

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95

DEDUCTIONS OF UP TO 20% will be made to the score received for content for errors in APA formatting, Spelling & Grammar; Clarity of ideas

No points will be deducted if APA format is excellent, and no errors in grammar, spelling, punctuation, or sentence structure, and ideas are clearly prese

The number of points deducted will be determined on the number of errors found within the paper as a whole, and at what point the student is at in th A general idea is as follows: APA format is in far below average with > 30 errors in APA/grammar/spelling and ideas are unclearly presented. (20 point deduction). APA format is below average; >20 errors in grammar or spelling; Ideas are not clearly presented. (15 point deduction) APA format is average; <10 errors in grammar or spelling; Ideas are almost always clearly presented. (10 point deduction) APA format is good; <5 errors in grammar or spelling; Ideas are clearly presented. (5 point deduction) APA format is excellent; No errors in grammar or spelling; Ideas are clearly presented (0 point deduction.) TOTAL AFTER DEDUCTIONFO R WRITING:

90%

Katie, Great work with this final practicum synthesis paper! All sections of the rubric were nicely addressed.The resources used appeared to be primarily texts and only a couple appeared to be research studies.greater incorporation of current research would have strengthened. Also theory could have been expanded to more closely relate Rogers theory as well as the Tech Acceptance Model.so there was a deduction in those areas. Otherwise, sections were clearly addressed. It sounds like this was a great learning experience and that your preceptor truly valued your contributions Overall, writing was strong, though there were some APA errors and typos or other writing errors noted throughout. Some were just suggestions for conciseness so not a major deduction in that area. Aside from the identified issues though, this was a very strong paper and sounds like a very successful practicum experience! Im glad I was able to see you complete your last course in the program Katie.it has been a pleasure to see you grow over the years and I hope to hear from you in the future as you progress in your career