Answer

Applying Technology in Nursing

Introduction

McKinly is intending to provide better quality services and improve the care given to its clients through the Picture Archive and Communication System (PACS), an effort spearheaded by the medical imaging department in an effort to not only improve quality but also reduce the costs. Standing on its way are a host of organizational, political, economic and managerial constraints. The imaging department continues to see an increase in patient load, prompting the implementation of the PACS, DDVR and CR computing programmes in the future. The PACS implementation will have to destabilize the traditional bureaucracy, upsetting communication channels and hierarchy in the process. McKinly has invested in choosing the PACS that best suits its interests in terms of digital imaging, and because of the economic, workflow, training and political uncertainties that are involved in the process, the organization is unsure if they should go ahead with the process and risk it all or shelve it altogether.

Results/Analysis

The decision to adopt PACS as a system within the imaging department was informed both by the increasing number of patients and the desire to reduce the skyrocketing costs. The adoption of this system had the potential of improving efficiency, but it did come with some risks.  The results of the intervention can be explained through the eight dimensions developed by Sittig and Singh.

Hardware and Software Computing Infrastructure

 This is a purely technical dimension that deals with the physical devices like the computer, printers, monitors and other entry devices that can be used to access and retrieve clinical applications and medical devices (Abdekhoda et al 2016). It includes the operation system and power that these computers use. The PACS implementation involved the use of digital scanners, digital systems, film equipment, computers and even chemicals that were all to be used to produce digital images.

Clinical Content

The dimension covers textual and numeric data from imaging devices or scanned from paper-based sources (Sittig and Singh, 2010). It may include aspects of the patient’s condition like laboratory test results and radiographic images. The PACS to be used had to have the capacity to receive image data and store them for retrieval. They allow for simultaneous viewing of the images. The images are also stored and can be reviewed by the radiologist s they see fit.

Human Computer Interface

This aspect includes human computer interactions. It involves the hiding of complexities that may result from the use of computers and the comfort of the healthcare personnel while at work on the computers. The PACS remove some of the technicalities that traditional imaging methods presented (Abdekhoda et al. 2016). First, they permit simultaneous immediate access to images, so that clinicians can review the images concurrently while at the hospital or in the field. As opposed to films, they do not need a lot of space for storage, and their retrieval is time-consuming too.

People

It involves all the people taking part in the design, development and implementation of HIT. It looks at the user and how the system developed would suit them. It requires that these users are educated about the system design and use. The implementation of the most effective PACS was arrived at after consultations and deliberations from the Steering Committee, the Leadership group, the User Group and the Technical Advisory Group. These people are trained, together with the radiologists, on the best ways of digitizing analog film and video, data communication, data storage and image distribution.

Workflow and Communication

This dimension deals with ensuring that the patient gets the care they need when they need it and that there is sufficient collaboration for positive health outcomes (Sittig and Singh, 2010). The PACS transition time demands that workflow changes are clearly defined and understood. At McKinly, this is considered supreme because failure to define these changes may lead to duplication of efforts, lost time and reduced productivity. In addition, it may also cause complications when the radiologists do not understand the changes that come with the PACS use. Immediately after PACS implementation, productivity actually declines as the radiologists begin the learning process.

Internal Organizational Policies, Procedures and Culture

This dimension of the model is a nod to the fact that PACS interventions have to work to preserve and improve organizational culture and that the procedures adopted are consistent with the policies that the organization values (Abdekhoda et al. 2017). In this case however, the PACS implementation presents McKinly with the possibility of upsetting the normal bureaucracy. There would be what is considered downward communication, not lateral amongst the staffs that are to implement the measures.

External rules, regulations and pressures

These are a host of federal, state and council regulations that control the use of technology systems in healthcare settings. At McKinly, it is the ultimate goal to make the imaging department of radiology filmless. However, there is always need for hardcopy films for legal, educational and other unforeseen reasons. The integrity, confidentiality and availability of data in compliance with the Health Insurance Portability and Accountability Act (HIPA A) are included in the security concerns.

System Measurement and Monitoring

The impacts of HIT have to measured and monitored regularly. It involves assessing to what extent they are used by clinicians to achieve desired outcomes, the effectiveness of the system in terms of the patient health improvement and the unintended consequences of the system. Assessing how much the PACS bring units like radiology and surgery together for the goal of improved patient outcomes is a good monitoring mechanism.

Discussion

For the PACS interventions adopted to function effectively, they had to be applied in view of the eight dimensions described above. Overall, the interventions had the potential of improving radiology department and imaging in general. It however had political, financial, motivational and training challenges that the implementation has to overcome.

This result was aided by a match in some of the dimensions and the way they were applied. The hardware and software infrastructure that were assembled and centralised for optimal functioning in terms of digitising films and images were the first in determining how effective radiology could be achieved. This dimension combined with the clinical content, helping to store and efficiently retrieve the data necessary for review by clinicians and other users concurrently in the field and within the hospital itself. In addition, the human computer interface facilitated the practicability of these dimensions because the users found fewer complexities while dealing with the issues of storage, retrieval and image review.

Moreover, the people dimension that ensured that users could develop, use and evaluate the system gave them the autonomy to implement best practices that were geared towards patient safety. Complying with the external regulations and rules made it possible for the PACS interventions to be supported by the regulatory authorities thus strengthening the systems (Pynoo et al. 2012). Consistent measurement and evaluation of the PACS system gave the system the capacity for consistent improvement. Even though there were challenges to overcome, these made its implementation and use a success.

Conclusion

As discussed above, the case presented an array of organizational behaviour risks and benefits that the use of a hospital wide information system presents. The implementation of PACS as an alternative to traditional radiology methods within the Imaging department presents endless possibility in terms of efficiency, cost-effectiveness and quality improvement. However, the use of computer based systems also presents certain institutional and personal challenges that risk upsetting the usual bureaucracy. It is for this reason that McKinly is in a great dilemma.