NURS 718 Week 1 Discussion Board Forum 1 on the DNP and Health Information Systems Example

Discussion Board Forum 1: Information Systems and the DNP Role

NURS 718 Informatics, Technology and Trends for Transforming Health Care, Discussion Board Forum 1

Thread by [Student Name]

The health system and the classmates replied to are composites written for a model discussion.

Last year our three-hospital system moved its emergency departments to a new electronic health record. The project team spent eighteen months on the build, with physicians, pharmacists and information technology staff at the table. Emergency nurses were invited to review screens six weeks before go-live, when changes were no longer possible. On the first day, we discovered that the triage screen asked for the patient's full medication list before the acuity level, which meant a patient having a stroke could wait while a nurse scrolled through medications. Within a week, nurses had built a paper workaround. Nothing about the technology was wrong; the decisions behind it had been made without the people who knew how triage worked. Over the next three months, nurses submitted more than forty change requests, most of which could have been avoided by a single afternoon of workflow observation during the build. Each request had to wait in a queue behind pharmacy and billing fixes, and in the meantime the paper workaround became the real triage process, invisible to the quality reports that still drew on the electronic record.

That experience convinced me that choosing and changing information systems is a clinical leadership decision, not only a technical one. Tan and Payton (2010) describe health management information systems as integrated systems of people, processes and technology meant to support decision-making in health organizations, a definition that puts people and processes before hardware. Zaccagnini and White (2017) describe the DNP Essential on information systems and patient care technology as preparing nurses to evaluate, select and use systems that improve and transform care, which implies a seat at the table long before go-live.

Evidence from nurses who have lived through record transitions supports this. When Brunner et al. (2026) asked bedside nurses and nurse informaticists what they had learned from switching records, the advice they distilled ran to ten points, among them writing the organization's own guidance instead of trusting the vendor's, pacing education to staff readiness, rebuilding workflows with nurses before launch and putting nurses into the governance that decides later changes. Kleib et al. (2026) found in interviews with 22 nurses working in informatics roles that their clinical knowledge was what qualified them, while unclear roles and limited support held them back. A system built without nurses will be used by nurses anyway, through workarounds that no one designed and no one monitors.

For DNP-prepared nurses, I see three roles. The first is translator, describing clinical workflow in terms analysts can build. The second is evaluator, insisting on usability testing with real nurses before go-live and on measures afterward. The third is governor, holding a seat on the committees that set priorities, so nursing needs are weighed alongside financial and technical ones. None of these roles requires a DNP to become a programmer. They require the ability to see a system as part of the care process, to gather evidence about how it performs and to speak for patients and nurses in the rooms where technology decisions are made. Solomon observed that plans succeed through many counselors (English Standard Version Bible, 2001/2016, Proverbs 15:22); our triage screen failed because the counselors who mattered most were consulted too late.

Reply to Teresa

Teresa, you described your clinic's frustration with documentation screens that take longer than the visit itself, and you suggested the answer is more training, perhaps a refresher each quarter. I would add that design may matter more than training. When three dozen ICU nurses tried both designs in random order in a simulation lab, a record prototype that arranged information spatially rather than in a linear flowsheet cut documentation time by 27% and lowered measured workload by about half, while improving accuracy (Taylor-Vaughan et al., 2026). Training cannot achieve gains of that size if the screen itself scatters information. That finding fits Tan and Payton's (2010) emphasis on systems that support decision-making: a system that makes clinicians hunt for data works against its own purpose. For your clinic, a DNP-led request might be to have three nurses and a provider time how long common visit types take to document, then bring those times to the vendor or the informatics team as evidence for redesign. Numbers like that turn a complaint into a requirement, and they give the informatics team a way to measure whether a redesign actually helped. Do you know whether your organization has a process for requesting design changes, or does every request go through the help desk?

Reply to Andrew

Andrew, your point that rural hospitals adopt technology more slowly because of cost is important, but cost is only one barrier. A 2026 mixed methods systematic review of digital health technologies for managing chronic conditions in rural areas found barriers that included technical problems such as software instability and hardware issues, poor internet connectivity, financial constraints and workforce limits such as staff shortages and heavy workloads (Sahakyan et al., 2026). The review organized these findings using an implementation framework, which shows that rural adoption depends on infrastructure and people as much as on budgets. That matters for your critical access hospital's plan to expand telehealth: buying the platform will not help if the connection drops during visits or if the one nurse covering the emergency department cannot step away to run a session. Zaccagnini and White (2017) emphasize that the DNP should evaluate technology in the context of the setting, and your setting's connectivity and staffing are part of that context. The review also identified facilitators, so it might be worth looking at which of them your hospital already has, such as staff who are comfortable with video visits or a manager who champions the change. Would a connectivity test across your service area be a useful first step before your hospital signs a contract?

References

Brunner, J. A., Amano, A., Gauntlett, L., Sullivan, S. C., Krein, S. L., & Davila, J. A. (2026). Recommendations for improving EHR transitions: Nursing perspectives from three healthcare systems. Medical Care, 64(1 Suppl. 1), S91-S99. https://doi.org/10.1097/MLR.0000000000002233

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Kleib, M., Darko, E., Strudwick, G., Shaben, T., & Paul, P. (2026). The roles and contributions of informatics nurses in clinical practice: A qualitative study. CIN: Computers, Informatics, Nursing, 44(3). https://doi.org/10.1097/CIN.0000000000001469

Sahakyan, S., Akseer, S., Abrahamyan, L., Metcalf, O., Allin, S., Chenhall, R., & Seto, E. (2026). Barriers and facilitators to implementing digital health technologies for remote management of NCDs in rural areas: Mixed methods systematic review. Journal of Medical Internet Research, 28, Article e93875. https://doi.org/10.2196/93875

Tan, J. K. H., & Payton, F. C. (2010). Adaptive health management information systems: Concepts, cases, and practical applications (3rd ed.). Jones and Bartlett.

Taylor-Vaughan, L., Helena, M. W., Silva Torres, G. E., Shea, K. D., Reed, P. G., & Gephart, S. M. (2026). Spatially integrated electronic health record prototype improves usability and reduces cognitive load for intensive care nurses: A randomized crossover trial. Applied Clinical Informatics, 17(3), 604-614. https://doi.org/10.1055/a-2903-5822

Zaccagnini, M. E., & White, K. W. (Eds.). (2017). The doctor of nursing practice essentials: A new model for advanced practice nursing (3rd ed.). Jones & Bartlett Learning.