NURS6412: Analysis of Clinical Information Systems and Application to Nursing Practice

Workflow analysis is the systematic examination of how work actually gets done — the sequence of tasks, decision points, people involved, information exchanged, and tools used to accomplish a clinical goal. In nursing informatics, workflow analysis matters because EHR implementations that ignore existing workflows create documentation systems that are burdensome, error-prone, and resisted by nurses. A medication administration workflow, for example, involves scanning the patient's armband, scanning the medication barcode, confirming the five rights, documenting administration in the MAR, and often simultaneous assessment documentation. If the EHR requires multiple additional clicks, requires navigating to different screens, or doesn't surface the right information at the right moment, nurses will develop workarounds that bypass safety checks. Nurse informaticists conduct workflow analysis BEFORE building the system (to understand the current state and design the future state) and AFTER go-live (to identify where the implemented system diverges from actual nursing workflow and create optimization solutions).

Clinical decision support is technology that provides clinicians with the right information at the right time to improve healthcare decisions. In EHRs, CDS takes many forms: interruptive alerts (pop-up notifications that require clinician action before proceeding — highest workflow impact, reserved for high-severity situations like a critical drug-drug interaction), passive alerts (Best Practice Advisories that appear in context but don't require action), order sets (pre-built groups of orders for specific clinical scenarios like sepsis protocols or AMI treatment), documentation templates (structured flowsheets that guide complete assessment documentation), dashboards (at-a-glance displays of patient status or panel-level data), and predictive alerts (AI-generated risk scores like sepsis early warning systems). NURS6412 teaches informaticists to design CDS tools using an evidence-based process: identifying the clinical problem, selecting appropriate CDS type, building the intervention, testing for alert fatigue, implementing with stakeholder buy-in, and evaluating clinical impact.

Usability is the degree to which a system can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction. In clinical systems, usability directly affects patient safety: a medication ordering screen that is confusing may lead to dosing errors; a nursing documentation template that requires too many clicks may lead nurses to skip documentation. The NIST definition of usability in healthcare EHRs focuses on learnability (new users can quickly learn the system), efficiency (experienced users can work quickly), error prevention (the system makes errors difficult and forgiveness when they occur), memorability (infrequent users can return without relearning), and user satisfaction. Jakob Nielsen's 10 usability heuristics — visibility of system status, match between system and real world, user control and freedom, consistency and standards, error prevention, recognition rather than recall, flexibility and efficiency of use, aesthetic and minimalist design, help users recognize and recover from errors, and help and documentation — provide a framework for evaluating any clinical interface. NURS6412 applies these principles to specific EHR evaluation exercises.