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A Value-Based Project Management Approach to Optimizations
Wednesday, March 2, 2016
Kris Wilson, PMP, MHA, RT (R) (MRI) (CT), Regional Director, PMO Hawaii Health Systems East Region
Kathie Crane, RN, MSN, Director, Clinical Informatics and Epic Application Service
Conflict of Interest Kris K. Wilson
Has no real or apparent conflicts of interest to report.
Kathie N. Crane
Has no real or apparent conflicts of interest to report.
Agenda • Review of learning objectives
• Introductions
• Issue
• Interventions
• Standardization of Project Methodology
• Conclusion
• Recommendations
Learning Objectives
• Organize optimization requests from multiple facilities and
departments using a project management approach to decide what
gets worked on first using a value-based decision making process
• Manage your team culture and team resources efficiently by defining
value at the initiation of an optimization and measuring added value
at closing
• Identify ways to prioritize requests based on the value of the solution
An Introduction of How Benefits Were Realized for the Value of Health IT
http://www.himss.org/ValueSuite
• All Value Steps have been
impacted
• Charting deficiencies
decreased from 84% to
1% (S,T,E,P,S)
Kris Wilson
• Regional Director, Information Systems & PMO
• Hawaii Health Systems East Hawaii
• Certified PMP
• Clinical Background in Radiology
– Certified RT (R) (MR) (CT)
• Masters Health Administration
• 17 Years in the Healthcare Field
• Directly involved in strategic planning and implementation
Kathie Crane
• Director, Clinical Informatics and Epic Application Services
• Health Systems Informatics (HSi)
• RN, MSN in Informatics
• Health Care 21 years
• Health IT / Informatics 15 years
• Focus on obtaining value from Health IT
Hawaii Health Systems East Hawaii Region
Hilo Medical Center (HMC) is the largest facility in the Hawaii Health Systems Corporation (HHSC)
Largest employer on the island, over 800 employees
Government Union(s): HGEA & UPW
276 licensed beds
8,608 acute admits, 442 long term care admits
Specialties/Services
Emergency Services – Level 3 Trauma Center (41,100 visits)
OB/GYN (1,100 births)
Surgery (3,200 patients)
Intensive Care
9 Outpatient Clinics (29,800 visits)
Oncology Clinic
Hawai’i • Safety-net hospital providing significant
care to the uninsured, underinsured, and
vulnerable populations.
• Service area: 100 miles
• Population: 111,217 people
• Medicare/Medicaid Payer Mix: 76%
• Per Capita Personal Income: $30,844
www.hawaiicounty.gov
Background
• Implemented EHR in May, 2010
• Limited Funds / Limited Resources
• Challenged with Multiple Priorities
System Maintenance
Vendor Updates for code fixes
Regulatory Requirements
• Set the Bar Past: Successful projects are “on time” & “on budget”
• Did Not Settle for “good enough”
Conflicting Priorities
Mandates Environmental 7am Shift Change
Tuesday Change Control
Third Thursday of the Month
First Day of the Fiscal Year
Conflicting Roadmap
Resources Culture
• Fixed Resources
• Immediate Attention
• Last Minute Fixes
Interventions
Before
After
Formation of New Team and Culture
Physicians
Nursing
Administration
IT/EHR
Team
Define work (prioritize) based on value
EFFORT
Regulatory
Optimization
Project
Important process change: Organize/Prioritize all based on value add HARD Return on Investment
– Cost Savings
– Increased Revenue
– Avoid Penalty
SOFT Return on Investment
– End User Efficiency
– Satisfaction
– Increased Productivity
– Ease of Access
– Greater Adoption
– Better Organizational Controls
CPOE
PDOC
Data Exchange
Patient Portal
Meaningful Use
Prioritization Tool based on the
value of the solution
986
768
282
0
200
400
600
800
1000
1200
MEWS CIWA Protocol ICU Mobility
Value Add Score
Prioritization
Review:
Identify ways to prioritize requests based on the value of the solution
Standardized the Process: Project or Optimization
Project Optimization
Adopting a Project Management Approach
Project Methodology
Initiating
Planning
Executing
Risk Monitoring & Controlling
Closing
Project Management of Knowledge, Version 5 (2013)
Project Methodology
Enterprise
Environmental
Factors
Organizational
Process Assets
Policies
Economics Culture
Knowledge Base
Systems Data
Project Methodology
Enterprise
Environmental
Factors
Policies
Economics Culture
Project Methodology
Project Statement of Work
Business Case
Contract
Project Charter
Project
Management Plan
Project Charter Project Plan
Work Performance
Reports
Change
Requests
Project Plan
Updates
Project Mgnt Plan
Performance
Reports
Change Requests
Approved Change
Requests
Project Mgnt
Plan Updates
Project Mgnt Plan
Accepted Deliverables
Final Product or
Transition to
Service
Organizational
Process Assets
Project Charter Mission • Why is this important to the organization as a whole
Business Case • Easily done using the added value identified during completion
of the prioritization tool
• Include expected before and after metrics
Objectives • Very clear description of what success looks like
Deliverables • Include Metric Goals established during prioritization
Scope
• Restates Purpose and Justification
• High Level Requirements
• Boundaries
• Deliverables
• Acceptance Criteria
• Constrains
• Renames Stakeholders
Owner • Who is accountable for achieving the value, including
signatures
Other items • Assumptions, Roles and Responsibilities
Standardize Required
Documentation for all
requests
Project Initiatives
Integration Growth
Clinical Operations
Financial &
Revenue Cycle
Operations
Technical Infrastructure
Operational Efficiencies
Departments
Nursing
Administration
Ancillary Services
Physicians
Information Technology
Business Office
Revenue Cycle
Outpatient Clinics
Review: Organize optimization requests from multiple facilities and departments using a project management approach to decide what gets worked on first using a value-based decision making process
Integrated Process- Bed Board
Admissions
• Assigns Bed in BB upon receipt of communication to admitting order
Emergency Department
• Communication to admitting order in MT
Receiving Unit
• Places Bed Reservation in BB
Emergency Department
• Places Bed Request in BB
Physician
• Places Admit Order in MEDITECH
Patient is Discharged &
Room is Stripped
Room is marked “Dirty”
Housekeeping views bed
board for dirty room
Room is Cleaned
Room is Marked “Make
the Bed” on Bed Board
ED Throughput Times
Tracking Value
Project: PowerScribe 360 Figure 5: Imaging Studies Volume and Pt. Satisfaction Scores
“Waiting Time for Radiology Tests”
Benchmark: 85 Mean Score
Decreased Imaging Report Turn Around Times
From 72 Hours to 5 Minutes
Hard Metrics:
Satisfaction
Domino Effect:
- Radiologist satisfaction
- Faster turnaround times in ER
- Referring provider satisfaction results in more referrals
- Improved coding and abstracting
- Patient satisfaction
Review the Impact
Improved Financials
Less Time
Increased Productivity
Improved Charge Capture
Decreased Error Rates
Higher Confidence
Better Access to Information
Less Clicks
End User Satisfaction
Evaluating Value at Closing
• Review Project Charter for stated goals
• Review Scope Document for strategic objectives
• Perform quantitative analysis (if applicable)
• Perform qualitative analysis (if applicable)
Evaluate
• Did we reach our goals?
• Did we make improvements?
• Were we successful? What could we do differently?
Ask the Questions...
Review: Manage your team culture and team resources efficiently by defining value at the initiation of an optimization and measuring added value at closing
Project Methodology
Organizational
Process Assets
Knowledge Base
Systems Data
VALUE
Conclusion
• Culture Change
• Structured Approach
• Success Measured in Value Based Outcomes
An Introduction of How Benefits Were Realized for the Value of Health IT
http://www.himss.org/ValueSuite
• All value steps have been impacted
• Improved IV Documentation
improved accuracy of information
and revenue capture by $2.9M
(T,S)
• Patient Portal (S,T,P) increased
utilization to 10%
• Workflow Improvement Project
(T,E,S) decrease TAT for Imaging
Exams from 72 hours> 5 minutes
film savings, saved department
over $350K annually
Questions
• https://www.hilomedicalcenter.org
• https://www.linkedin.com/in/kris-wilson-307b4369
• Tweet @kctweet1
• https://www.linkedin.com/in/kathie-crane-rn-msn-b936325
• www.hsi-corp.com
