NR 515 Week 2 System Inventory for One Referral Example

Course	NR 515 Informatics in Healthcare
Week	2
Paper type	System inventory
Length	About 1,140 words, 3 pages
Format	APA 7 student paper
School	Chamberlain University
Program	MSN, Nursing Informatics
Updated	September 2026

Free sample paper for NR 515 Week 2

System Inventory: Every Piece of Software a Cardiology Referral Touches at a Six-Provider Family Practice, Who Answers for Each, and the One Record That Should Be Authoritative

Student Name

College of Nursing, Chamberlain University

NR 515: Informatics in Healthcare

Instructor Name

Month Day, Year

What this page is doingThe title fixes one process and promises an owner for each system and a single authoritative source, the three things the inventory is graded on. Student APA 7 title page.

System Inventory: Every Piece of Software a Cardiology Referral Touches at a Six-Provider Family Practice, Who Answers for Each, and the One Record That Should Be Authoritative

The Process Walked

The process inventoried here is a routine outpatient cardiology referral at a six-provider independent family practice, from the moment a physician decides a patient needs to see a cardiologist to the moment the cardiologist's consultation note is in our chart and a physician has read it. I walked the process for three real referrals in August, with the front desk lead and the referral coordinator, and listed every system that held any part of it. No patient details are included here.

The referral loop is widely known to leak. In a study of more than 100,000 referral scheduling attempts in a large health system, Patel et al. (2018) found that only 34.8% ended in a documented completed appointment. A small practice has fewer systems than a large one, but as the inventory shows, not few enough for anyone to hold the whole process in mind.

The Inventory

Table 1 lists each system, what it holds, who answers for it, which way data move and whether it is the authoritative source for referral status.

Table 1

Systems Touched by One Cardiology Referral

System	What it holds for this process	Answerable party	Data in, out or both	Authoritative?
Electronic health record (EHR), referral order	The order, reason, urgency, attached notes, a status field	EHR vendor for software; practice office manager for configuration	Both	Yes
E-fax server and inbox	Outbound referral packet; inbound appointment confirmations and consult notes as images	E-fax vendor; referral coordinator for the inbox	Both	No
Referral tracking spreadsheet on the shared drive	Patient, date sent, specialist, authorization number, appointment date, note received	Nobody formally; maintained by the referral coordinator	In only	No
Insurer prior authorization portal	Authorization request and decision	Each insurer	Both	No
Cardiology group's scheduling system	Appointment date and attendance	Cardiology group	Neither, from our side (we cannot see it)	No
Patient portal	Messages from patients asking about their referral	EHR vendor; nurses for the message queue	In	No
Office phone system and voicemail	Calls from the cardiology office and patients	Telephone vendor; front desk	In	No
Hospital community portal	Cardiology notes when the cardiologist also works at the hospital	Regional hospital	In	No

What the Table Does Not Show

The enterprise rows are the least interesting. The EHR and the e-fax server have vendors, contracts and support numbers. The row that matters most is the spreadsheet. It is the only place in the practice where anyone can see, in one view, which referrals have been scheduled, which have been seen and which have come back. The referral coordinator built it four years ago because the EHR's referral status field was not being updated, and she updates it by hand from faxes and phone calls. It has no owner in any job description, no backup and no audit trail. When she was on leave for two weeks in the spring, nobody updated it, and nobody could say which referrals from those weeks had closed.

The second hidden row is the cardiology group's scheduling system. It is the true source of whether an appointment was made and kept, and we have no access to it. We learn about appointments only when the cardiology office faxes a confirmation, which it does inconsistently, or when the patient tells us.

The phone system also carries referral data that never reaches a record. A message on the voicemail saying the patient missed the appointment is heard, sometimes written on a sticky note and sometimes entered in the spreadsheet.

What this page is doingThe narrative spends its length on the informal rows, the spreadsheet and the invisible scheduling system, because that is where the process actually lives.

Choosing the Authoritative Source

The inventory marks the EHR referral order as the authoritative source for referral status, and that choice needs defending, because in practice it is not true today. The EHR is the only system with an owner, an audit trail, a link to the patient's chart and a backup. The spreadsheet has none of these. The problem is that the EHR's status field is updated only when the order is created and sometimes when it is closed, so it is authoritative in design and empty in use.

Marking the spreadsheet authoritative would describe current practice honestly but would endorse a record nobody is responsible for. Marking the EHR authoritative sets a direction: every status change the coordinator now records in the spreadsheet should be recorded in the EHR order instead, and the spreadsheet should be retired once the EHR shows the same information. Mehrotra et al. (2011) noted that primary care physicians often do not know whether a patient saw the specialist or what the specialist recommended. In our practice, the answer exists, but only in a file one person keeps.

A practical test of the choice is what happens when the coordinator is away. If status lives in the EHR order, any nurse covering her work can open the patient's chart and see where the referral stands. If status lives in the spreadsheet, the covering nurse has to know the file exists, find it and trust that it is current. The inventory makes the case for the EHR on that test alone.

Flows and Gaps

Data leave the practice through two channels, the e-fax and the insurer portal, and return through four: fax, phone, patient portal and the hospital portal. None of the returning channels updates the EHR order automatically. Every return depends on a person noticing an item and moving it somewhere else. The consultation note, which closes the loop, arrives as a faxed image that must be indexed to the chart by hand before any physician sees it.

The inventory therefore finds that the referral process in this practice is held together by one staff member's spreadsheet and a series of manual transfers. That is not a failure of the people involved, who have kept it working. It is a sign that the process was never designed as a whole.

Seen through the eight-dimension sociotechnical model of Sittig and Singh (2010), most of these gaps sit outside the software. The hardware and software dimensions are largely sound. The trouble is in workflow and communication, where every returning item needs a person to move it, and in the internal organizational policies dimension, where no policy says who owns the spreadsheet or how quickly an inbound consult note must be indexed. A software purchase alone would leave both untouched, which is why the inventory's first recommendation is a change in who records status and where, not a new product.

References

Mehrotra, A., Forrest, C. B., & Lin, C. Y. (2011). Dropping the baton: Specialty referrals in the United States. The Milbank Quarterly, 89(1), 39-68. https://doi.org/10.1111/j.1468-0009.2011.00619.x

Patel, M. P., Schettini, P., O'Leary, C. P., Bosworth, H. B., Anderson, J. B., & Shah, K. P. (2018). Closing the referral loop: An analysis of primary care referrals to specialists in a large health system. Journal of General Internal Medicine, 33(5), 715-721. https://doi.org/10.1007/s11606-018-4392-z

Sittig, D. F., & Singh, H. (2010). A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality and Safety in Health Care, 19(Suppl. 3), i68-i74. https://doi.org/10.1136/qshc.2010.042085

What the NR 515 Week 2 assignment asks for

The Week 2 assignment asks you to inventory the information systems involved in a clinical or administrative process at your workplace or a realistic setting. Typical prompts ask you to list each system, its purpose, who manages it, how data enter and leave it, and how it connects to others, then to identify gaps or risks. Choosing one process keeps the inventory manageable and meaningful. Include informal tools such as spreadsheets, shared inboxes and phones, since these often carry the most important information. Many sections expect a table plus a narrative. Check whether your section asks you to mark an authoritative source, and whether a diagram is required or optional.

Inside the NR 515 Week 2 example

The example opens with the process and how it was walked: three real referrals, followed with the front desk lead and referral coordinator, with no patient details recorded. A referral-loop study sets the stakes. Table 1 lists eight systems with five columns each. The narrative then explains what the table cannot show: the spreadsheet that holds the only complete status view, the specialist's scheduling system the practice cannot see, and voicemail messages that never reach a record. A section defends marking the EHR order as authoritative and sets a direction to retire the spreadsheet. A final section uses a sociotechnical model to show that most gaps lie in workflow and policy.

Where the points sit in the NR 515 Week 2 rubric

Rubrics for the system inventory usually reward completeness, accuracy and analysis. Completeness means the inventory captures the systems a process actually uses, including informal ones. Accuracy covers each system's purpose, owner and data flows. The analysis criterion, often the largest, rewards a narrative that identifies risks, gaps and the authoritative source, rather than repeating the table. Graders also look at organization, since a clear table makes the rest of the paper easier to follow. Scholarly support is expected in the narrative. The remaining points cover APA 7 format for the table and the references, and clear, concise writing throughout the paper. An inventory that states plainly which systems the writer could not see into is usually read as more trustworthy, not less.

NR 515 Week 2 help: mistakes that cost points

The biggest mistake is listing only the enterprise systems, the EHR and the billing software, and missing the spreadsheet, the fax inbox and the phone. Those informal rows are usually where the process lives. Another mistake is an owner column filled with vendor names only; say which person or department at your organization answers for each system. Students also mark two systems as authoritative, which avoids the hard choice. Pick one and defend it. Keep the narrative from repeating the table line by line. Finally, remove any patient information from examples, and be careful describing another organization's systems, since you often cannot see them and should say so.

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NR 515 Week 2 questions, answered

How many systems should the inventory contain?

There is no target, and a padded table is easy to detect because the extra rows have nothing in the answerable-party column. A single referral process at a small practice honestly walked usually surfaces somewhere between six and a dozen, once the desk log, the outside portal and the fax folder are counted alongside the electronic record and the billing system.

What if two systems both look authoritative?

Say so plainly in the commentary, because that finding is worth more than a clean table. Two authoritative copies of the same item means somebody is reconciling them by hand, or nobody is and the discrepancy waits to be discovered by a clinician. Name which copy each department actually trusts, and the disagreement becomes the most useful paragraph in the assignment.

Does the inventory need a diagram?

Only if the section asks for one. The table carries the content, and a diagram added for decoration usually contradicts it because the two were built at different moments. Where a picture is required, draw the same rows in the same order with arrows for direction, and check that every box in the drawing corresponds to a row in the grid.

Where can I find a free NR 515 Week 2 sample paper?

The referral inventory printed above is a full NR 515 Week 2 sample, table and narrative included, open to any reader. For an inventory of another process, such as medication refills, tell us the process and a free version is prepared.

How many systems should the NR 515 inventory include?

Include every system the process actually touches, which for a single process is often six to ten. The sample lists eight, including a spreadsheet, a phone system and a portal the practice does not own.