A small community hospital in the Midwest has used a homegrown information system for years. The system began in the early 1970s with a financial module. Over time, additional modules were added. A limited number of departments selected a commercial system and interfaces were used to integrate these into the overall functionality of the hospital information system. Except for physicians, most in-house clinical or care-related documentation is online. However, about 15% to 20% of this documentation is done by free text and is not effectively searchable. In addition, the screens, including the drop-down and default values, were built using terms selected by the in-house development team in consultation with clinical staff; thus there is no data dictionary or specific standard language. In the last few years, the hospital has purchased two outpatient clinics (obstetrics and mental health) and a number of local doctor practices. The clinics and doctors offices are now being converted to the hospital administrative systems. A few of the clinical applications that are tied directly to the administrative systems such as order entry and results reporting are also being installed.

A major change is being planned. A new chief information officer (CIO) was hired last year and she has appointed a chief medical information officer (CMIO) and a chief nursing information officer (CNIO). No other significant staff changes were made. With her team in place, one of the CIOs first activities was to complete an inventory of all applications. Rather than continue to build, a decision was made to switch to a commercial vendor and the hospital selected a commercial system.

As a member of the clinical staff with informatics education, the CIO has requested that you develop a training and information presentation for the clinical staff that will:

• Identify two or more issues with the existing system
• Provide staff with appropriate work-around for using the existing system
• Provide an overview of two of the standard languages used within the new system including discipline or specialty, updating frequency, and available cross-maps
  • One standard language should pertain only to nursing
  • One standard language should be multidisciplinary.
• Obtain clinical staff input, using a five-question survey, of specific methods to support transition to the new system; questions should be open-ended.