Project Management

Project Management • “How Do I Get From Here to There?” • The Role of Project Management in Your EHR Implementation

Objectives: • Identify 2-3 phases of an EHR implementation • Identify 2-3 critical leadership issues for a successful EHR

Project Management • Two Rules to Live By: • “If you don’t know where you are going, any road will get you there.” • “All systems are perfectly designed to achieve the results they deliver”

Project Management • What is a project? • A temporary endeavor undertaken to achieve a specific aim • In this presentation, we will focus on a particular project: the successful implementation of an EHR in your practice • What is project management? • “Project management is the application of knowledge, skills, tools, and techniques to project activities to meet project requirements.” (PMBOK, 2003)

Project Management • A project is comprised of phases: • Each phase is defined by completion of one or more deliverables • Deliverable = a tangible work product • The project phases of an EHR Implementation look like the EHR Roadmap: • Assessment • Planning • Selection • Implementation • Evaluation • Improvement

Project Management • Roadmap also follows the PDSA cycle:

Assessment Assessment

Assessment • Assessment phase is comprised of: • Developing a project charter • Determining budget • Creating a project team • Aligning the organization to the project’s goals

Assessment – Project charter • Developing a project charter • A charter documents what you plan to accomplish: • Organization’s vision and goals • Scope • A good scope details not only what is included in the project, but also what is specifically excluded from the project • Benefits • ROI as well as ROE (return on effort) • Tangible and measurable, as well as ‘soft’ benefits

Assessment – Budget • Determining your budget • Realistic expectations of cost: • EMRs cost $15-50K per provider (based on AC Group - 7/15/04) • What is your cost tolerance? • What are you willing and able to spend? • While the budget doesn’t need to be exact, you do need at least a ballpark figure: • Very robust solution = large investment and transformational change $$$ • Superior solution = more incremental change, keep it close to the current practice $

Assessment – Project team • Creating a project team • Leadership: • Financial staff are partners, rather than drivers • Clinical projects should be driven by clinical leaders • Having an EHR ‘champion’ is critical to project success • EHR champions are: • Communicators • Teachers • Respected peers • But not necessarily the most computer savvy staff • Executive leadership is key • Broker the partnership between the clinical staff, business staff, and vendor

Assessment – Project team • One role does not necessarily equal one person • In smaller organizations, one person may share more than one role • In larger organizations, you may find that some roles are split over a few specialists • Honest evaluation of implementation skills in the practice • Has anyone led an implementation before? • Has anyone tested software before? • Has anyone taught staff before? • Who can handle the tech issues?

Assessment - Other • Aligning organization to the project goals • Share the charter with the team • Recognize that changes may be required based on feedback from other members of the practice • Consider adding to the project team staff who have strong opinions about the project

Assessment • Deliverables at the end of this milestone: • DOQ-IT application and needs assessment completed • Project Charter written and communicated • Vision and Goals • Budget estimate • Benefits • Project team identified • Current workflows documented and evaluated

Planning Have you ever had this nightmare?

Planning • Now that the project has been defined, it’s time to put together a plan • Supports your project scope • Develops a structure for the project • Steps in developing a project plan: • Develop a timeline • Outline the key milestones and deliverables • Gain support with key stakeholders • Initial research for vendor selection • Develop an implementation model

Planning – Time Line • Develop a time line • Based on DOQ-IT experiences, the following time frames are a good estimate of the time needed for an EHR implementation: • Vendor selection (1-3 months) • Contracting (1 month) • Implementation (2-4 months) • Training and ‘Go-Live’ (2 weeks) • Consolidation of gains (3-9 months) • Evaluate (1 month) • Improve (On-going)

Planning – Milestones and Deliverables • Outline the key milestones and deliverables • This task will bridge the ‘Planning’ and ‘Selecting’ project phases. • In the planning phase, you only need to develop broad-brushstroke of the key milestones • More planning will need to be done at each additional phase, but it is important to put together a framework

Planning – Gaining Support • Gain support for the project with key stakeholders • Identify stakeholders • Importance of communication • Communicating about the project is easier and more comprehensive if you develop a communication plan • Staff meetings • Newsletters • Announcements at meetings with other stakeholders • Materials should be directed to a specific audience • Frequent updates

Planning – Preparing the Groundwork • Vendor selection is a balancing act

Planning – Preparing the Groundwork • Prepare for vendor selection • Vendors: 250+  10  5  2-3  1 • Preliminary research (250+  10  5) leads to a “short list” of vendors • Trade shows • DOQ-IT • Web research • IPA/PHO recommendations • Local vendor presence

Planning – Preparing the Groundwork • Vendor Selection • Request for Information (RFI) / Request for Proposal (RFP) process • RFI is usually more informal than an RFP • Standardized approach to collecting vendor information • Ability to use a rating and weighting system to help with the selection process • Many communities submit a collective RFI/RFP

Planning – Preparing the Groundwork • Completed RFI/RFP is submitted to “short list” of vendors • Lot of information to go through • RFI/RFP process is taxing for vendors • “Short list” of vendors can then be narrowed down to 2-3 finalists • These are the vendors who will return for demonstrations

Planning – Implementation Models • Developing an implementation model isn’t as simple as deciding when to turn the computers on • A few important decisions to make: • Multiple sites • ‘Big Bang’ vs. incremental • Managing productivity losses • There is a way to push productivity losses near zero dollars - there is also a way to reduce the time during which productivity is down to near zero days • These are not the same plan • You need to balance acceptable productivity losses with the length of the transition, implementation, and training period

Planning – Implementation Models • Managing multiple sites • Consider starting with a smaller pilot site • Test workflow redesign ideas • Proof of concept for the rest of the group • Take advantage of smaller group of enthusiastic providers • Bring all sites up together if a primary goal of the implementation is to reduce chart runs between sites • Let organizational goals drive the implementation • Instant productivity gains from reduced chart runs will offset productivity losses elsewhere

Planning – Implementation Models • Incremental vs ‘Big Bang’ • Selecting appropriate implementation strategy one of most important decision practice will make • Each style has its merits • Detailed projects plans will increase the chances that the implementation succeeds

Planning – Implementation models Ways to implement incrementally:

Cons: Potential for getting stuck partway through an implementation Can be exhausting – imparts the feeling that things are always in flux Hybrid paper/EMR system is confusing Planning – Implementation models • Pros: • Great for building groundswell in practices where there is not a pro-EHR consensus • Can prevent productivity losses • Limits implementation pains to one group or function at a time • Allows for plenty of time to fix kinks in workflow and process changes Incremental implementation

Planning – Implementation models ‘Big Bang’ implementation • Pros: • Great for small practices where all providers are excited about the EMR • Takes advantage of enthusiasm • Shorter implementation • No paper/EMR hybrid issues • Cons: • Higher chance of failure • Does not allow for time to fix kinks in workflow, network issues, or technical glitches • Significant productivity losses • Workflow glitches can provide a reason for providers’ non-adoption

Planning • Deliverables at the end of this milestone • Timeline for the project • Rough list of key milestones and deliverables based on your vendor selection process and implementation model • RFI or RFP developed and a process for your EHR vendor selection • Communication plan • Clinic staff • Other stakeholders • Preliminary meeting with key stakeholders on implementation models

Selection

Selection • Selection phase consists of three types of tasks: • Ongoing planning tasks • Execution Tasks • Finalize vendor selection • Make hardware choices • Negotiate the contract • Prepare the office space • Controlling Tasks

Selection – Ongoing planning • Ongoing planning tasks • Continue to develop the key milestones and deliverables • Not necessarily a linear progression • Need input from your selected vendor to complete this process • Complete the practice assessments of workflow and office space

Selection - Execution • Execution Tasks • Finalize vendor selection • Moving from the RFI/RFP process  Vendor demonstrations • Need to examine the product in two different ways: • Structured demonstrations address the concerns and requirements of your practice • Vendor driven demonstrations showcase the software product • DOQ-IT has vendor evaluation tools when you are ready to begin the process of rating

Selection - Execution • Reference Checks • Two options for checking references – site visits and telephone calls • In either case, you will get the most out of your efforts if you: • Select a site that is a good match for your size and type of practice • Use a structured tool for evaluation of a site • Send this tool to the site, allowing them to highlight your areas of concern

Selection - Execution • Negotiating a contract • There are many aspects to contract negotiation • Training • Implementation • Hardware • Third-party software • Technical support • And many more… • The contract that the vendor gives to you will protect them – you want to review the contract so that it protects you

Selection - Execution • Expectations of your vendor • The level of vendor assistance in project management will depend on your contract • The amount of implementation support offered/available/recommended varies wildly by vendor • If your vendor provides assistance, review their project plan to verify that it matches your needs • If your vendor does not provide assistance, all the responsibility is shifted to your practice

Selection - Controlling • Controlling Tasks • What is ‘scope creep’? • Uncontrolled changes to a project’s scope • Usually results in a project overrunning its budget and schedule • The scope creeps by adding new products, features, functions, or goals • Some scope creep should be expected • Inevitable result of originally lean budgets and schedules • Important to identify which cost/schedule overruns are acceptable and which should be left for another project

Selection - Controlling • Control of scope creep • Establish a change control process • Team should review all requests scope changes to determine how each request affects the project: • Schedule • Budget • Resources • Benefits of the change • Change control is a process that will be critical in all subsequent phases of the EHR implementation

Selection • Deliverables for this phase • Ongoing planning tasks • Completed current workflow and office space analysis • A complete list of all needed tasks, milestones, and deliverables for the vendor and the practice • Execution tasks • Vendor demonstrations • Selection of a vendor • Negotiated contract with the final vendor • Controlling tasks • Changes to scope are documented and reviewed by the team before they are accepted

Implementation

Implementation • Implementation phase consists of three types of tasks: • Ongoing Planning Tasks • Execution Tasks • Sign a contract • Do the work • Controlling Tasks

Implementation – Ongoing planning • Now that you have an implementation plan from the vendor, you can finish the project plan • Include expected dates for all milestones • When setting milestones and outlining deliverables, be sure to manage both the responsibilities of your practice and the vendor • If they miss a deadline, it is your practice that will suffer • Assigning resources to each task and deliverable will allow other team members to begin working on the project

Implementation - Execution • Execution Tasks • Sign the contract • If your vendor’s implementation resources are heavily taxed, you may not want to delay this step • Each day you delay will push your implementation date out by more than a day • Communicate to stakeholders

Implementation - Execution • Do the work: • Install the hardware and software • Install the network and peripheral systems • Convert data from old systems to new system • Test and implement interfaces • Chart abstraction • Develop plan for chart abstraction • Begin the process of abstraction before ‘Go-Live’

Implementation - Execution • Do the work (cont’d): • System testing • Network • Interfaces • Hardware • Software • Training • To augment vendor training, ask your vendor for additional training opportunities • Could include training CDs, online resources, ‘dress rehearsals’, test patients, and remote login

Implementation - Controlling • Controlling Tasks • Continue to control scope creep • Scope is most likely to creep in this phase of the project • Including more participants in the process • The full resource requirement of each task will be more obvious • Monitor progress of tasks – both vendor and practice

Implementation • Deliverables for this phase • Planning Tasks • Working project plan that includes all of the tasks, milestones and deliverables • Execution Tasks • Signed contract • Regular communication with stakeholders • Clinic staff • Patients • Other entities • Work as listed above

Implementation • Deliverables for this phase • Execution Tasks (cont’d) • Go-Live plan completed • Go/No-Go meeting date set • Chart abstraction • Reduction in schedules • Implementation model decided and expectations communicated • First practice to go • “Big Bang” vs. incremental approach

Implementation • Deliverables for this phase • Controlling Tasks • Any changes to the scope of the project are reviewed by the team before being accepted • The project manager and team meet regularly to monitor progress • Anticipated missed milestones or deliverables are discussed • Mitigation plan in place

Project Management