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1
Project Management
“How Do I Get From Here to There?” The Role of Project Management in Your EHR
Implementation
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Objectives:
Identify 2-3 phases of an EHR implementation
Identify 2-3 critical leadership issues for a successful EHR
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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”
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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)
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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
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Project Management
Roadmap also follows the PDSA cycle:
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Assessment
Assessment
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Assessment
Assessment phase is comprised of: Developing a project charter Determining budget Creating a project team Aligning the organization to the project’s goals
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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
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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 $
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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
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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?
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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
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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
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Planning
Have you ever had this nightmare?
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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
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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)
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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
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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
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Planning – Preparing the Groundwork
Vendor selection is a balancing act
Vision andculture
Budget andresources
Cost andcomplexity of
the EHRimplementation
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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
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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
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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
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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
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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
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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
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Planning – Implementation models
PatientsStart with one patient on the first day, and document the entire visit. Add a few patients per day until the whole panel is on.
ProvidersLet your most enthusiastic provider start. Add one physician per week until even the pessimists are up and running. (Works out the kinks for the reluctant physicians.)
ModulesePrescribing, CPOE, Patient-physician communication tools, disease registry, full visit documentation, etc.
FunctionsPhone calls, prescriptions, billing, injections, labs, full visit documentation, etc.
Ways to implement incrementally:
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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
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
Incremental implementation
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Planning – Implementation models
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
‘Big Bang’ implementation
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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
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Selection
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Implementation
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Implementation
Implementation phase consists of three types of tasks: Ongoing Planning Tasks Execution Tasks
› Sign a contract› Do the work
Controlling Tasks
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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
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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
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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’
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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
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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
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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
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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
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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
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Evaluation
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Evaluation
Evaluation begins after the ‘Go-Live’ day You may find evaluation on the first day to be a bit
taxing Begin evaluating the project as soon as you can
discern patterns emerging
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Evaluation
Execution Tasks Continue with your communication plan Conduct additional training as needed Initiate a plan for training new hires Conduct a post-implementation audit/survey of
selected stakeholders
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Evaluation
Controlling Tasks Evaluate evolving practice performance against the
benefits and ROI defined in your project charter› If benefits have not been realized
» Evaluate the expected benefits: Were they realistic? Can they still be realized?
» Was the implementation effective?» What steps can you still take to realize the project vision
and goals? Re-examine your scope to identify any changes that
were not part of the original plan
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Improvement
Improvement Improvement is an on-going component of the process,
and can be seen as the beginning of a new PDSA cycle
What else can you do to improve office efficiency and productivity?
What else can you do to improve patient care in your practice?
› Use of evidence –based guidelines› Participation in P4P programs
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Did We Meet The Objectives:
Identify 2-3 phases of an EHR implementation Identify 2-3 critical leadership issues for a successful
EHR