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Addressing the Pitfalls of Government Health Information Technology Implementation Projects
December 2014
Authored by:
Foster C. “Bud” Beall, Jr., MAPeggy C. Evans, PhDJeff Hummel, MD, MPH Qualis HealthSeattle, Washington
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 2 of 14
Introduction
Regulatory requirements and advances in technology are
exerting considerable demands on federal, state, and
local government agencies to implement new information
systems or update existing ones. Government healthcare
agencies, including state Medicaid agencies, have
been especially impacted. Recent federal policies have
mandated implementation of Medicaid Management
Information Systems (MMIS) that comply with Medicaid
Information Technology Architecture (MITA) standards1.
The Affordable Care Act requires participating government
agencies to adopt technology that can deliver advanced
functionality (e.g., health insurance exchanges). And
other innovative technologies are being adopted with the
intention of greater efficiencies and cost savings. The
resulting system implementation projects are complex in
nature, large in size, and new in scope.
Because of the complexities of these new projects,
government technology implementation projects run
a high risk of failure, resulting in products that are
not implemented on time, on budget, or able to fulfill
the business needs that prompted the technology
procurement and implementation in the first place. Several
highly visible technology implementation failures have
captured the public eye in recent years, including the
healthcare.gov rollout in support of the Health Insurance
Marketplace, a cornerstone of the Affordable Care Act.
Additionally, several state MMIS implementation failures
have resulted in lawsuits over unpaid claims and public
backlash over spending of taxpayer dollars.
Case Study: One State Medicaid agency began its
original MMIS implementation in 2003 and went-live with
a significantly flawed system three years later. After initially
spending $25 million, this agency spent another $30
million dollars addressing the system issues only to be
faced with the realization after six months of being unable
to pay claims that the MMIS would never be able to meet
federal certification requirements. Four years and $55
million dollars later into the MMIS implementation project,
the agency decided to decommission the system and
start over with a new procurement that ultimately resulted
in a successful go-live three years later.
The Issues
There are multiple factors that contribute to the failure of
an implementation project.
Complexity and Scope: Government technology
implementations are inherently large, multi-year projects.
For example, Medicaid claims systems, eligibility systems,
and other Medicaid enterprise systems serve large
populations, process large volumes of data, and must
integrate with a number of other state systems. As a
result, there is a significant probability that a government
technology implementation project will not meet the
project goals and objectives. In fact, studies have shown
that larger projects are ten times more likely to fail3, and
are twice as likely to be late, over budget, and missing
critical features at go-live.
Because of the long duration of implementation
projects, the operational and technological environment
may change in the period between project start and
completion. New regulations, changes in organizational
priorities, and other external business factors may impact
requirements and project schedules. This can affect the
continuity of project staffing and may result in a loss of
project direction. The sheer number of project activities
Studies have shown that larger projects
are ten times more likely to fail3, and are
twice as likely to be late, over budget,
and missing critical features at go-live.
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 3 of 14
and issues can obscure the strategic vision and goals
set forth at the beginning of the project. Deficiencies in
project management plans and methods can allow key
project work plan dependencies to be missed, resulting
in significant scheduling delays and bottlenecks.
Unrealistic Expectations and Competing Priorities: A major system implementation involves and impacts
a diverse community of stakeholders associated with
an organization. It requires participation of executive
leadership, management, line staff, project management
and implementation teams, business partners, customers,
and numerous other community stakeholders that will
use or interact with the new system. This universe of
stakeholders will possess a set of goals, needs, and
priorities which can often conflict with one another.
Organizational expectations often begin to diverge as
early as the procurement process. Procurement rules
and system requirement priorities can create conflicts
and mixed messages that result in the acquisition of a
system that cannot possibly meet all expectations.
Over-emphasizing “low cost” or a specific set of functional
or technical requirements, for example, can create barriers
and limitations that have downstream impacts potentially
impeding the implementation process and resulting in a
system lacking the functionality to meet key operational
objectives. At the same time, procurement requirements
can incentivize software vendors to overpromise to win
contracts, further setting unrealistic expectations and
increasing the risk of a failed implementation.
Throughout the implementation project, maintaining
common goals, priorities, and expectations is a significant
challenge. “Political” and competitive divisions among
stakeholders impede the collaboration and coordination
necessary to ensure that an efficient and integrated
system solution is deployed. Ignoring or neglecting
conflicts further erodes an organization’s ability to
accurately set and manage expectations. This lack
of coordination often leads to unnecessary software
customization, replication of current inefficient business
processes, unrealistic project plans, strained relationships
between stakeholders, and ultimately a system that does
not sufficiently meet the organization’s needs.
Unproven Systems: The risks associated with the
implementation of newly developed or custom developed
systems are much higher than those associated with
systems that have a proven track record of success. Over
the past 10 years, a number of states have experienced
implementation delays, measured in years, and poor
performance associated with adopting these types of
unproven systems.
Lack of coordination often leads to
unnecessary software customization,
replication of current inefficient
business processes, unrealistic project
plans, strained relationships between
stakeholders, and ultimately a system
that does not sufficiently meet the
organization’s needs.
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 4 of 14
because “hundreds of critical user test cases were not
executed.7” The State Auditor also noted that the user
acceptance testing (UAT) and operational readiness
validation processes were flawed. The State Auditor
found that there were no established user acceptance
criteria by the state, a lack of clear benchmarks, and
acceptance criteria that was ultimately developed by
the vendor, creating a conflict of interest that resulted
in the state being unable to accurately assess software
operational readiness or system sufficiency. As result,
when the North Carolina MMIS system was fully deployed
in an operational setting, software defects and inefficient
system flows became readily apparent that were not
previously identified.
Lack of Transparency: Implementation project
management teams typically consist of a project
management office (PMO) supported by consultants and
other contract staff, with the group tracking and reporting
on project status, issues, and risks. In recent problematic
or failed projects, it was determined that senior leadership
and other key stakeholders were unaware of the depth
of issues and risks associated with their projects. The
PMO did not effectively communicate timely and accurate
project status (see case study about the Oregon health
insurance exchange website rollout on page 6).
Case Study: One State Medicaid agency terminated
its contract with its MMIS vendor to develop a custom
system after investing millions of dollars in design and
development. Despite the fact that the vendor had never
developed a system, their proposal and pricing had
convinced the agency that their approach offered the
best value. However, after considerable project delays
and issues, and upon a thorough review of the vendor’s
blueprint for the project, the agency concluded that the
vendor did not “have the capacity to deliver the system
they proposed.”
Software development is a complex, resource intensive,
time consuming endeavor, and implementations
associated with new development are much more
complicated and more likely to experience schedule
delays and cost overruns. Because the likelihood of major
system defects increases greatly with these types of
implementations, the importance of testing, contingency
planning, and other quality assurance measures take on
even greater significance.
Inadequate Testing: Developing effective test plans
and strategies, and conducting comprehensive testing
procedures to validate system performance and accuracy
are long-standing industry best practices. However, overly
aggressive implementation milestones and project delays
experienced during the development and implementation
phases of projects can motivate organizations to truncate
test processes or bypass key testing activities altogether.
In an effort make up for lost time and meet “go-live”
dates, organizations may skip critical system validation
steps, undermining the integrity of the new system. For
example, the North Carolina State Auditor found that
one key reason for its failed MMIS implementation was
To improve transparency and offer
greater assurances of effective project
management, government projects
have utilized independent verification
and validation (IV&V) resources to
assist the PMO and provide a neutral
and independent assessment of
project effectiveness.
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 5 of 14
Case Study: Recently, the federal government and several
states across the U.S. experienced significant delays and
functional problems with the implementation of health
insurance exchange solutions, despite the fact
that the technology was developed by a number of
well-known software vendors. One State’s health
insurance exchange website suffered from a failed
implementation due to 1) ineffective communications
between leading state entities, 2) limited cross-agency
collaboration, and 3) lack of a single point of
authority to make decisions, among other key factors.
A post-mortem assessment of the implementation
indicated also that communication to leadership was often
“confusing” or “misinterpreted.” Members of the project
oversight committee indicated that they were unaware
of the IV&V vendor’s role and did not receive any of the
IV&V vendor’s reports that indicated concerns about the
project. This resulted in an erroneous understanding of the
true status of progress toward project deadlines.
To improve transparency and offer greater assurances
of effective project management, government projects
have utilized independent verification and validation
(IV&V) resources to assist the PMO and provide a neutral
and independent assessment of project effectiveness.
However, the key benefits of the IV&V function can be lost
due to potential flaws in the project reporting structure.
Placing IV&V in a subordinate role to the PMO and
prohibiting IV&V from reporting assessment results directly
to senior leadership increases the risks that key findings
and recommendations will be filtered, sanitized, or ignored
by the PMO. As a result, senior leadership may not be
aware of important issues and potential risks.
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 6 of 14
Mitigation Strategies
While government technology implementations can
be difficult because of the nature of the projects and
requirements, implementations can be successful with the
right experience and the right team in six key areas:
1) Planning
2) Leadership
3) System Validation
4) Project Monitoring and Metrics
5) Business Process Transformation
6) Risk Management
Below we discuss the key strategies government agencies
should take to have a successful implementation.
1) PlanningThe team must have a shared vision of the project
objectives, and maintain a strategic approach to
implementation that includes a focus on the milestones,
understanding the dependencies between project tasks,
and also the contingencies, which can be developed into
a project management plan. Additionally, the team will
want to create specific strategies for implementation,
communications, and change management at the outset
of the project.
Project Management Plan:
• Establishastrategic-levelmanagementplanand
schedule time to document major goals, constraints,
milestones, resource needs, and dependencies
based on consistently maintained detailed project
work plans.
• Beginningintheprocurementprocessandcarried
through design, development, implementation, and
post implementation, leadership must focus on the
project “critical path:” maintaining organizational
priorities, monitoring key milestones and
dependencies, and understanding the implications
of deviations from plan.
Too often projects get bogged down in issues that are not
critical to the success of the implementation. This results
in mission critical tasks, such as quality assurance (QA),
training, go-live/operational readiness, and testing phases
being truncated or abbreviated to meet milestones,
thereby increasing the risk of implementation failure.
Implementation Strategy:
• Establishanimplementationstrategythatallows
for phased functionality deployment, contingency
planning, operational readiness planning, and post-
implementation activities.
• Post-implementationactivitiesshouldprovidefor
system stabilization, performance monitoring, and
implementation of any deferred functionality.
These implementation activities fit within the standard
system development life cycle (SDLC) and align with
the key SDLC phases: design, development, and
implementation (DDI). Allowing for phased functionality
deployment provides for a more controlled system
roll-out, and helps to organize the larger, complex
implementation project into smaller, more
manageable subprojects.
Develop a communication strategy and
protocols early in the process to share
information between project managers,
operations, leadership, vendors, and
other key stakeholders, and adjust them
to meet changing project requirements.
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 7 of 14
Communication Strategy:
• Developacommunicationstrategyandprotocols
early in the process to share information between
project managers, operations, leadership, vendors,
and other key stakeholders, and adjust them to meet
changing project requirements. The approach should
reinforce project goals and criteria for success.
• Developmethodstomaintaininvolvementand
cooperation with diverse stakeholders through
reporting, meetings, town hall sessions, and
other forums.
As government agencies develop their communications
strategies, consider involving well-respected “champions”
as project advocates to work with project stakeholders,
reinforcing the goals and benefits of the new system. In
addition, the project will benefit from engaging potential
detractors to address their issues and concerns.
Suggestions for engagement of potential detractors
include providing a platform to share concerns, involving
them in developing solutions, and if feasible, incorporating
their recommendations in the project.
Change Management Strategy:
• Establishandimplementconsistentchange
management processes early in the project.
• Proceduresmustbeinplacetoensurethatonly
those system changes that are absolutely necessary
are made. Criteria must be established to determine
whether and when changes in design should be
allowed, and a governing body must be established to
review, evaluate, and approve system changes.
Business operations do not go on hiatus during the
implementation project, and as a result, environmental
changes and business demands may necessitate
changes to the design and functional requirements of
the new system. These changes, however, need to be
minimized, controlled, and managed properly. If not, an
inordinate number of system changes will adversely affect
development activities and undermine quality assurance
activities. On-going changes to design and functionality
do not allow for proper testing, and set the stage for
deploying a system with untested and potential
defective functionality.
2) LeadershipThe leadership of an implementation project is critical
to develop and maintain a shared vision for the project,
and to ensure that the implemented system ultimately
meets strategic and operational needs. There are several
components of effective leadership, described below.
Maintain Shared Vision, Strategic Focus,
and Commitment:
• Leadershipmustbeabletoarticulatewhycurrent
state operational processes and/or systems are
inadequate, a vision for an improved future state
including the benefits, and the business case for
making changes. Leadership should also have clear
understanding of the implementation project and
the business needs that the technology supports,
including identifying business cases for all major
business processes.
• Leadershipshouldensurethattheimplementation
team maintains a strategic approach keeping the
project moving toward established objectives,
including goals that may include deploying
business process improvements, achieving system
certification and meeting regulatory requirements.
• Beginningintheprocurementprocessandcarried
through design, development, implementation, and
post implementation, leadership must focus on the
project “critical path” of maintaining organizational
priorities, monitoring key milestones and
dependencies, and understanding the implications
of deviations from plan.
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 8 of 14
Government agencies must also live up to their
contractual obligations with vendors and other project
stakeholders, including providing appropriate staffing,
meeting deadlines, and completing administrative
functions (e.g., task orders, deliverables) in a timely
manner. Lack of engaged, visible, and committed
leadership throughout the project can impede the
timeliness of key decisions, impact project momentum,
and lead to cutting corners. This typically creates
vulnerabilities that make it more difficult to effectively
address vendor performance issues.
Communications with leadership:
• Developacommunicationplanthatinvolves
leadership to ensure they have enough information to
make informed decisions that have significant impact
on the project, such as procurement strategies,
financial management, and timelines.
To have a successful implementation, strategic reporting
to leadership needs to occur throughout the project
life cycle so that leadership is informed, has the ability
and knowledge to give feedback, can provide guidance
and remove barriers, and intervene with stakeholders,
vendors, and others, if necessary. Leadership can also
articulate decisions and the decision making process
to stakeholders, including business partners and the
taxpaying public.
Clear governance structure:
• Developanoversightstructuretoidentifyand
mitigate factors that increase risk of failure identified
in the planning stage. One element of the oversight
may be to establish a collaborative working
environment between the government agency
implementing the system, software vendor, IV&V,
and operating departments.
• Establishmulti-disciplinary,seniorlevelleadership
team to address and resolve conflicts and
set direction.
A well-defined governance structure, with clearly
identified roles and responsibilities, and communications
protocols with leadership should be identified early in
the implementation process. Governance leadership
can assist with addressing major disagreements and
interdepartmental conflicts, as well as pave the way for
difficult messages identifying potential issues and risks.
An independent IV&V function should be
in place to assist and monitor the PMO,
and to provide independent assessments
of project management performance and
project status to executive management.
Project Management (PMO) Accountability:
• Theprojectmanagementteamshouldworkclosely
with software vendors, operating departments,
and organizational leadership to plan, control, and
execute project activities. Projects must be led by the
government agency PMO, collaborating with vendor
project management teams, operating department
leadership, “governance bodies,” and the IV&V entity,
and not solely dependent upon a vendor to manage
the project.
• IfanexternalconsultantperformsthePMOrole,an
internal senior level project sponsor/manager must be
dedicated to collaborate with the PMO. Someone with
“authority” within the government organization must be
involved at the highest levels of project leadership.
• ThePMOfunctionmustconformtoindustrystandards
such as IEEE and Project Management Body of
Knowledge (PMBOK), and must be accountable to
engaged executive leadership. This accountability
must include frequent, consistent, and transparent
communication of project status, issues, risks, and
mitigation strategies through reports, dashboards,
and meetings.
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 9 of 14
• AnindependentIV&Vfunctionshouldbein
place to assist and monitor the PMO, and to
provide independent assessments of project
management performance and project status
to executive management.
An effective project management function is essential to
the success of any project. Recent surveys and research
all demonstrate that poor project management can
negatively impact a technology implementation9,10.
3) System ValidationIf appropriate testing planning, execution, and
documentation steps have been followed, the final “go/
no-go” decision will be meaningful. Without the proper
planning and documentation (data), the organization is
incapable of making an informed “go/no-go” decision. It
cannot be confident that an appropriate testing process
was completed and that results of the testing process
are truly indicative of the system’s performance in a
production environment.
Planning:
• Documenttestingstrategiesandactivitiesinatest
plan and comply with test plans.
• Ensurethattheprojectfollowspre-definedplans
by allowing for sufficient time and resources to
validate mission critical test cases in a designed,
systematic fashion.
• Testingprocessesshouldincludeadiversesetof
organizational stakeholders who will be reliant
upon the system.
• Exitcriteriaidentifying“acceptable”levelsofdefect
rates for all testing activities should be defined prior
to testing. Exit criteria establish the basis for
go/no-go decisions.
While nearly all major system implementation projects
will have an established test plan, complying with these
plans has been inconsistent. Complying with test plans,
defining user acceptance criteria, allowing sufficient time
for testing, and engaging a diverse set of stakeholders
who will use the system will be imperative for the success
of the implementation.
Documentation:
• Documentingtestcases,scripts,acceptancecriteria,
and results must be performed.
• Testcasesshouldreflectthecomprehensiveand
mission-critical business processes impacted
by the system.
• Loggingtestresultsandassigningclearlydefined
severity levels for defects helps the organization to
more effectively monitor and remediate quality issues.
Effective test documentation provides the organization
with a systematic approach to testing. Test cases, scripts,
and acceptance criteria establish a consistent method for
validating system performance and accuracy.
Execution:
• Duringtesting,softwaredefectsmustbeassigned
clearly pre-defined severity levels, documented
against the test case, and monitored. Staff
responsible for testing must have a unified (consistent)
understanding of defect severity levels, and should
not over or under state severities as realistic
assessments are critical.
• Largesystemimplementationsshouldincludetesting
activities by an internal or external IV&V or QA entity,
to independently validate the test results. Independent
testing will help to confirm test results and the
appropriateness of test cases. When this does not
occur, the government agency may be overly reliant
on the software vendor to accurately document and
report test results and system defects.
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 10 of 14
The software vendor and organization must work together
to ensure that key test phases include, at a minimum,
functional testing, integration testing, user acceptance,
and operational readiness testing. Departmental
operations staff must be included in testing and validation
of the system to ensure mission critical functionality is
fully operational, effective, and efficient prior to go-live.
4) Project Monitoring and Metrics
Monitoring:By the time that a project reaches the monitoring phase, it
is quite possible that there will have been changes to the
initial project plans. During this phase,
• Teammembersmustreviewprojectplansand
timelines to evaluate how the project is progressing.
• Teammembersmustmanagescopechanges,
report and mitigate project risks document and
store progress reports, and continue to inform and
engage stakeholders and leaders, according to the
communications plan.
• IfanIV&VorQAentityisengagedintheproject,
project monitoring would include partnering with the
IV&V or QA entity and others responsible for work
processes to make sure all activities are aligned with
the strategic plans and specifications.
• Teammembersshouldidentifyandimplementclear
metrics to monitor the progress of the project.
When monitoring and evaluating project metrics, it is
important not to suppress or ignore performance results
that indicate problems. Warnings are important indicators
of project status and should not be viewed as indicators
of “personal failure” or treated as a threat. They are
meant to provide feedback that must be evaluated and
addressed in order to identify and prioritize risk mitigation
strategies and promote improvement.
Equally important but external to the organization is to
ensure that the software vendor has the right staff for the
implementation (e.g., personnel that is adequately trained
and/or are experienced subject matter experts), and
that the vendor is well-staffed (e.g., has enough people
assigned to the project).
Gate Reviews for Medicaid-Related
Implementation Projects:
• Agatereviewwouldbetriggeredwhenthebulkof
work within a phase is complete based on pre-defined
exit and entrance criteria.
• Aprojectshouldnotmoveforwardwithouthaving
conducted a gate review, assessing results, and
developing or adjusting plans to mitigate risks and
implement corrective actions.
Conducting gate reviews is a CMS Enterprise Life Cycle
standard and is intended to provide oversight, guidance,
and coordination for large, complex information system
implementations to achieve higher levels of success
in Medicaid-related system implementations. Gate
reviews give project leadership a complete picture of
project status at a specific stage in the project, based
on quantitative and qualitative data, in order to support
decision making. This includes go/no-go decisions as to
whether the project is ready to close the previous phase
and transition to the next life cycle phase.
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 11 of 14
5) Business Process Transformation Many government agencies are in the midst of major
transformation of their IT systems and business
processes. State Medicaid agencies, for example, are
implementing systems that will allow them to employ
innovative reimbursement models, provide new healthcare
services, assist with eligibility expansion, and pilot test
new care delivery models. As business models change,
so must existing business processes, requiring a need for
business process re-engineering and communications to
support change management.
Business process re-engineering:
• Projectteamsworkwithinternalstafftoidentify
changes in processes that will help with project
design and implementation.
• Teammembersshouldpartnerwithvendorsto
develop process flow maps of how the software can
support operations. Attention to process flow will
be an essential component of successful change
management, empowering the operations staff who
must implement the technology and gaining buy-in
from other stakeholders.
• Ensurethatoperationsstaffisinvolvedinkey
workflow, system design, and system build decisions.
Government agencies should not rely solely on the vendor
or other support entities, such as outside consultants
or PMO-based analysts to make all decisions regarding
system design and new business processes. These
support entities can help to expedite workflow and system
design, but the operations staff is ultimately responsible
for these processes and must be involved. It is critical to
engage knowledgeable operations staff to re-engineer
business processes that effectively align with new
system functions, offer greater efficiencies, and comply
with business requirements. This involvement promotes
adoption and helps to head-off issues at go-live.
Performance metrics:
• Aspartofthebusinessre-engineeringefforts,itis
useful to collect data designed to inform whether
the new system and processes are generating
performance improvements.
• Defineandmeasurekeyperformanceindicators
before and after the new system is implemented.
Data can drive transformation by revealing whether
changes have an impact, and which changes have the
strongest effects.
It should be expected that initially performance will
decline as the organization acclimates to the new
system, however, with continued post-implementation
measurement, monitoring, and refinements, improvements
should be observed. Additionally, performance metrics are
also essential in determining whether software vendors
are meeting contractual obligations. The organization
will need to monitor and assess whether the vendor is
complying with Service Level Agreements and other
contract terms.
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 12 of 14
6) Independent Verification & Validation
IV&V is a valuable asset that informs and supports the
implementation, including support of leadership and the
PMO. However, when engaging IV&V, the organization
should strive to insulate the IV&V function from the PMO.
This is not to isolate the IV&V function, but to promote
objective and transparent performance feedback to
the organization by ensuring that IV&V findings and
recommendations are readily available to leadership.
Project Control:
• Optimally,IV&Vwouldbeinvolvedbeginninginthe
procurement process.
• TheIV&Vfunctionshouldbeengagedeffectivelyto
support the PMO in its efforts to plan, monitor, and
control the implementation project.
• TheroleoftheIV&Vteamshouldbetopromote
visibility, accountability, and fact-based decision
making for technology initiatives, increasing the
likelihood of a successful system implementation.
Through consistent and periodic IV&V assessments
focused on key activities most relevant to the
project phase or milestone, the IV&V entity will help to
ensure that 1) the system is designed and built upon
the proper requirements (verification); and 2) the system
functions as designed, works effectively in the intended
operating environment, ands meets performance
expectations (validation).
Risk Management:
• UseIV&Vtoidentifyhigh-riskareasearlyinthe
implementation project to allow businesses to either
mitigate risks or prepare for contingencies.
• IV&Vcanalsobeusedtorecommendremediation
strategies and steps, as well as monitor associated
resolutions and outcomes.
IV&V can provide support for project management efforts
by offering proactive guidance and advice. Additionally,
IV&V teams can nurture communications
and collaboration between your organization, system
vendors, and other stakeholders, assisting with issue
resolution as needed.
SummaryGovernment technology implementation projects have
high rates of failure because the requirements tend to
be complex and new to organizations, with far-reaching
business implications and the ability to impact a variety of
stakeholders. In the last five to ten years, numerous state
Medicaid MMIS implementation projects have suffered
highly visible failures, only to spend millions of dollars
more to correct initial errors.
However, technology implementation projects do not have
to fail. The recommendations presented in this document
describe critical elements that, if followed, will lead to a
higher probability of implementation success. The key
drivers of success will be giving the appropriate resources
to the project (staffing, attention), which means creating
and maintaining an experienced project team that can
align the implementation with the strategic roadmap, is
capable of leading the implementation tasks, and has the
ability to know when the project may be veering off path
and can bring it back to the center.
It might be helpful to contract with external parties to
assist you with aspects of your implementation project.
Experienced consulting organizations will have the benefit
of having been part of multiple implementation projects in
the government sector, and can bring those experiences
to your team.
Note to Reader: This paper contains examples of government health information technology projects that have experienced implementation problems. The information presented in project examples and the Case Studies was collected through research of readily available materials, and is not related to any current or past Qualis Health client project. Qualis Health has not provided any project or client specific information in this paper.
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 13 of 14
About Qualis Health
Qualis Health is one of the nation’s leading population health management organizations, and a leader in improving care
delivery and patient outcomes, working with clients throughout the public and private sector to advance the quality,
efficiency and value of healthcare for millions of Americans every day. We deliver solutions to ensure that our partners
transform the care they provide, with a focus on process improvement, care management and effective use of health
information technology. We have experience offering a broad range of IV&V, quality assurance, and project oversight
expertise to a range of different government clients.
Whereas other consulting firms often provide a “check-the-box” approach to technology implementation project
oversight, Qualis Health collaborates with our clients to enable an approach that fits your unique implementation needs.
We have broad and detailed understanding of the technology implementation issues facing government agencies today
based on the experiences we have gained through the completion of other projects in the public and private sector.
Our consulting team consists of senior level consultants or managers that possess a minimum of 10 years of related,
real-work experience. Each member of the team has extensive experience with a variety of state and local government
agencies and demonstrates skills in one or more of the following areas: information technology, project management,
business and clinical operations, management, and technical operations.
The consulting team has access to Qualis Health subject matter experts from departments throughout our company. This
includes healthcare and health IT professionals with care management, quality improvement, and practice transformation
experience. Qualis Health professionals are active in the healthcare marketplace and can bring to your organization a
comprehensive understanding of trends, best practices, regulatory requirements, and advances in technology.
For more information about Qualis Health’s services, please contact
Bud Beall, Vice President of Consulting Services at [email protected].
Addressing the Pitfalls of Government Health Information Technology Implementation Projects | Page 14 of 14
References
1 Friedman, H.R. (2007). Medicaid Information Technology Architecture: An Overview.
Health Care Financing Review, 28 (2), 1-9.
2 Harvey, B., & Chacon R. An inside look at Maine’s MMIS Implementation. Government Health IT, July 19, 2011.
Retrieved June 25, 2014 from www.govhealthit.com/blog/inside-look-maines-mmis-implementation.
3 The Standish Group. CHAOS Manifesto 2013. Boston, MA: The Standish Group International, Incorporated, 2013.
4 Hayes, H.B. Why are Medicaid MIS contracts failing? Government Health IT, October 30, 2009. Retrieved June 25,
2014, from www.govhealthit.com/news/why-are-medicaid-mis-contracts-failing.
5 Nebraska nixes multi-million dollar contract. (2009). Retrieved June 25, 2014, from
journalstar.com/news/local/nebraska-nixes-multimillion-dollar-contract/
article_1b90dd1e-7e36-11de-83a2-001cc4c002e0.html.
6 Richardson, V. Colorado unveils Obamacare tax to boost struggling state exchange.
The Washington Post, June 10, 2014. Retrieved June 25, 2014, from
www.washingtontimes.com/news/2014/jun/10/colo-unveils-obamacare-tax-boost-state-exchange/.
7 Wood, B.A. Performance Audit, Department of Health and Human Services,
NCTracks (MMIS Replacement) – Implementation. Raleigh, NC: Office of the State Auditor, May 2013.
8 First Data Government Solutions. Cover Oregon Website Implementation Assessment,
Assessment Report. Atlanta, GA: First Data Corporation, April, 2013.
9 Chen, C.C., Law, C.C.H, & Yang, S.C. (2009). Managing ERP implementation failure:
A project management perspective. IEEE Transactions on Engineering Management, 56 (1), 157-170.
10 Bloch, M., Blumberg, S., & Laartz, J. Delivering large-scale IT projects on time, on budget, and on value.
Insights & Publications, McKinsey & Company, October 2012. Retrieved June 25, 2014, from
www.mckinsey.com/insights/business_technology/
delivering_large-scale_it_projects_on_time_on_budget_and_on_value.