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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