SDLC in nursing informatics: plan, analyze, build

An informatics nurse lists the current eMAR's functions next to those the new barcode workflow will require and documents what is missing. This activity is:

1. a gap analysis
   A gap analysis sets the current state beside the required future state and documents what is missing, here eMAR functions the barcode workflow needs.
2. a feasibility study
   A feasibility study judges whether a proposed solution is technically, economically, and operationally viable, not which functions are missing.
3. a needs assessment
   A needs assessment establishes the problem and what users need in the first place; comparing an existing system with target requirements is the gap analysis that follows.
4. a system-wide impact analysis
   An impact analysis traces how a change will ripple through other systems, interfaces, and workflows rather than listing missing functions.

A feasibility study finds that nurses' current workflow and unit culture would not support using the proposed system as designed. This finding concerns which type of feasibility?

1. technological
   Technical feasibility asks whether the hardware, software, and infrastructure can support the system, not whether nurses' workflow fits it.
2. economic
   Economic feasibility weighs costs against expected benefits, which the finding does not address.
3. schedule
   Schedule feasibility asks whether the project can be finished within the required time frame.
4. operational
   Operational feasibility asks whether the organization's people, workflow, and culture will actually use the system as designed.

An EHR upgrade will change how medication concentrations are coded in orders. Besides pharmacy, which system most needs to be included in the impact analysis?

1. the patient portal medication list
   The portal displays the medication list, but it does not act on concentration codes to deliver an infusion, so the safety impact is far smaller.
2. the ADT registration system
   ADT handles admissions and transfers and does not use medication concentration data.
3. the smart pump drug library interface
   Pump interoperability passes order details, including concentration, to the pump and its drug library, so a coding change can cause mismatches or programming errors there.
4. the laboratory information system's interface
   The laboratory information system interface exchanges test orders and results, not medication concentrations.

A facilitated workshop in which nurses, physicians, pharmacists, and analysts work together to define and agree on requirements for a new order set is called:

1. a stakeholder focus group
   A focus group gathers opinions and perceptions, but it is not a facilitated working session that ends in agreed requirements.
2. joint application design
   Joint application design brings users, subject experts, and analysts into structured, facilitated sessions to define and agree on requirements quickly.
3. a heuristic evaluation
   A heuristic evaluation has usability experts inspect an existing design against principles; it does not define requirements.
4. a Delphi study
   The Delphi method builds consensus through anonymous rounds of questionnaires, with no face-to-face workshop.

A quality measure requires counting patients with a stage 2 or higher pressure injury. Which documentation design most reliably supports this measure?

1. A free-text wound description field
   Free text varies from nurse to nurse and cannot be counted reliably without manual review.
2. NLP applied to wound notes after discharge
   NLP on narrative notes adds error and lag; it is a fallback for unstructured data, not a design choice for a new measure.
3. A coded pick-list for injury stage
   A discrete coded field for stage can be counted reliably by a query, which is what a quality measure needs.
4. A comment box beneath the wound photo
   A comment box is free text, so staging is hard to extract and count consistently.

To reduce documentation burden in a new admission assessment, the design team should first:

1. remove fields that no regulation or care need requires
   Reducing burden starts with cutting fields that no regulation, policy, or clinical use requires, so nurses document only what is used.
2. change most coded fields to free text for speed
   Free text may feel faster but loses the structure needed for decision support, reporting, and quality measures.
3. add copy-forward to every section of the assessment
   Widespread copy-forward saves clicks but carries old findings forward as if newly assessed, a safety and legal risk.
4. make every field optional so nurses can skip them
   Making everything optional lets required data go missing without reducing the clutter that causes the burden.

A new alert states only 'Potassium abnormal,' with no value, trend, or recommended action, and nurses ignore it. Adding the value and an evidence-based next step addresses the CDS:

1. right format
   Format is the kind of intervention, such as an alert, order set, or infobutton; the fix here changes content, not form.
2. right channel
   Channel is the medium, such as the EHR, a portal, or a mobile device; the alert already reaches nurses through the EHR.
3. right information
   The right information right means the content is relevant and actionable, here the value, trend, and a recommended next step.
4. right time in workflow
   Right time in workflow is not the gap here: the alert fires when the result posts; what is missing is its content.

To review navigation across all 12 screens of a new admission workflow, the team builds a clickable model of every screen, but none of the screens saves data. This is a:

1. evolutionary prototype
   An evolutionary prototype is refined step by step into the production system; nothing here suggests the model will become the real build.
2. vertical prototype
   A vertical prototype builds one function deeply and in working form, the opposite of a clickable shell of all screens.
3. horizontal prototype
   A horizontal prototype shows the breadth of the interface, every screen and the navigation between them, without working functions underneath.
4. minimum viable product
   An MVP is a working product with just enough features for real use; screens that save no data are not usable.

While designing a wound care database, the analyst must show that one patient can have many wounds and each wound many assessments. The appropriate diagram is a(n):

1. data flow diagram
   A data flow diagram shows how data move between processes and stores, not the cardinality of relationships.
2. entity-relationship diagram
   An entity-relationship diagram models entities, such as patient, wound, and assessment, and the one-to-many relationships between them.
3. cross-functional swimlane diagram
   A swimlane diagram shows who performs each step of a process; it models workflow, not data relationships.
4. decision tree
   A decision tree maps choices and outcomes for decision logic, not database structure.

In a knowledge-based clinical decision support system, which component applies the stored rules to a patient's data to produce a recommendation?

1. The inference engine
   The inference engine applies the knowledge base's rules to the patient's data to generate advice.
2. The user interface
   The user interface displays the recommendation and collects input but does not reason over the rules.
3. The knowledge base
   The knowledge base stores the rules and facts; it does not execute them on its own.
4. The interface engine
   An interface engine routes and translates messages between systems; mixing it up with the inference engine is a common slip.

The system will not let a nurse file a blood transfusion administration until a second nurse's credentials are entered. This design is a:

1. hard stop
   A hard stop prevents the user from continuing until a condition is met, such as a second nurse's credentials for a transfusion.
2. passive alert
   A passive alert shows information without interrupting or blocking the workflow.
3. default order
   A default is a preselected value or order; it shapes choice but does not block filing.
4. soft stop
   A soft stop warns but allows the user to proceed, usually with an override reason.

Nurses override a new fall-risk alert 95% of the time because it fires at login, before any assessment has been documented. Which CDS 'right' is most clearly violated?

1. Right channel for delivery
   The EHR is an appropriate channel for this alert, so delivery medium is not the issue.
2. Right time in the workflow
   Right time in the workflow is violated: firing at login, before any assessment is documented, puts the alert where it cannot be meaningfully acted on.
3. Right person receiving the alert
   Nurses are the right recipients for a fall-risk alert; the problem is when it fires.
4. Right format for the message
   An alert may be a suitable format; it fails because of its timing in the workflow.

A new worklist signals overdue medications only by changing the patient's name from black to red. The main accessibility concern is that:

1. red is reserved for allergy warnings
   There is no universal rule reserving red for allergies; the real problem is using color as the only signal.
2. color-blind users cannot perceive the cue
   Relying on color alone breaks accessibility guidance (WCAG), because users with color vision deficiency cannot see the change; pair color with text, an icon, or position.
3. many colors on one screen add alert fatigue
   Alert fatigue comes from too many interruptive alerts; a single color change is not alert overload.
4. red text is hard to read when printed
   Printing is a minor issue for a live worklist and does not address users who cannot see the color on screen.

When designing a nursing assessment flowsheet, rows such as 'lung sounds' should generally default to:

1. the previous shift's value
   Carrying forward the previous value invites unverified documentation of findings that may have changed.
2. the most common finding on the unit
   Prefilling a typical finding encourages accepting it without assessing the patient.
3. within normal limits
   A WNL default documents a normal assessment that may never have happened.
4. blank until the nurse enters a finding
   Leaving assessment rows blank forces an active entry, so the record reflects what was actually assessed this time.

Which deliverable translates approved requirements into detailed screen layouts, data fields, and rules for the build team?

1. Test plan
   A test plan describes how the build will be checked, not how it should be built.
2. Project charter
   The charter authorizes the project and sets its high-level scope, long before build detail exists.
3. Requirements document
   The requirements document states what the system must do; translating it into build detail is the next deliverable.
4. Design specification
   The design specification translates approved requirements into screen layouts, data fields, and rules that the build team can follow.

For a new wireless phone system, the team assesses who will carry the phones, how calls will be routed during rounds, and whether coverage reaches every room. This analysis addresses:

1. structure, process, and outcome.
   Donabedian's structure-process-outcome model evaluates quality of care, not the readiness of a technology rollout.
2. strengths, weaknesses, opportunities, and threats.
   Strengths, weaknesses, opportunities, and threats (SWOT) is a strategic planning tool for internal and external factors, not an analysis of users, workflow, and coverage.
3. technical, economic, legal, and operational feasibility.
   Feasibility dimensions are used to decide whether to pursue a project; the stem describes planning how it will work in use.
4. people, process, and technology.
   Who will use the phones, how the work will flow, and whether the technical coverage works are the three dimensions of the people-process-technology framework.