Chapter 4

1. Chapter 4 EHR Project Management: Roles in Design and Implementation

2. Prerequisites for EHR Success • Planning • An EHR project should not be viewed solely as an IT project • Executive Management Support • EHR projects are long-term, expensive undertakings • Obtaining executive management support is a critical prerequisite to a successful EHR

3. Prerequisites for EHR Success • Medical staff ownership • Medical staff will be some of its primary users. • Our healthcare environment is truly information-based, and members of the medical staff are also coming to that realization • Use a physician champion • The physician champion must understand change management

4. User Involvement • Users include clinicians as well as administrative, financial, and other persons who rely on the health record to carry out their responsibilities in support of the healthcare facility. • User concerns: • Users need to understand that they are not being replaced or required to work harder.

5. Resources • EHR design and implementation will require resources: • Appropriate • Sustained • For example, building the cost of the EHR into another strategic project, such as building a center of excellence or adding a new wing, links the EHR to the organization’s strategic initiatives.

6. Project Scope and Characteristics • Have a defined beginning and end, usually follow a standard SDLC, and have a defined budget* • Are a line function, though with special staffing often through volunteerism from many parts of organization • Concern something new and therefore involve uncertainty and change • Require great attention to detail, while maintaining the ability to see the big picture

7. * EHR Projects • EHR projects become ongoing programs • Spiral life cycle results from many modules and additional components being added to the core functionality • Precautions must be taken to keep an eye on project milestones, budget, and goals to ensure all components are completed

8. Project versus Program

9. Project Sponsor Steering Committee Project Manager CIO Nursing Documentation Medical Staff Pharmacy Ancillaries Ambulatory Domain Teams MAR PFS Orders HIM RCM Vendor Consultants Temporary Staff Project Management Resources Example

10. EHR Steering Committee

11. EHR Project Manager • Tasks • Supports steering committee • Responsible for overseeing project completion • Qualifications • General contractor • Understand EHR • Healthcare background • Project management • Leadership skills • IT skills not as important as vision and leadership • Clinical knowledge can be a plus

12. HIM Checklist to be Involved • Make yourself an expert • Help others gain expertise • Make sure you receive credit as the expert • Take on volunteer assignments • But don’t volunteer “beneath” your goals; i.e., do not volunteer to take minutes • Educate – yourself, your staff, physicians, administration, vendors, patients

13. HIM Checklist Think front end, while keeping back end in view • EHRs are intended to be used at the point of care for care delivery • Documentation is important, but secondary to care delivery Think outside of the box so front end supports back end

14. Project Manager Skills • Leadership – not necessarily “leader” • Communication • Listening, speaking, reading, writing • Up, down, peers, partners • Internal team, external vendors, internal customers, external public • Negotiation – reaching consensus • Problem Solving – requires: • Problem definition • Decision making • Influence – but not necessarily “POWER”

15. Team Building • There is no “I” in team! • But there are stages of group development: • Forming • Storming • Norming • Performing • Adjourning

16. Meetings

17. Integration management Planning Change control Scope management Authorization Planning Time management Activity definition Sequencing Duration Schedule development and control Cost management Resource planning Cost estimating, budgeting, and control Quality management Project performance Monitoring results Human resource management Organization Staff acquisition Team development Communications management Planning and distribution channels Performance reporting Administrative closure Risk management Manage adverse events that may stall or derail project Procurement management Planning solicitations Source selection Contract management Project Management Standards See: Project Management Institute

18. Project Phases and Life Cycle

19. Project Phases and Life Cycle • Initiating processes • Project formulation, feasibility studies, and strategic design and approval • Planning processes • Goals and time line parameters • Executing processes • Actual implementation steps • Closing processes • Implementation of benefits realization studies using the metrics previously defined • Controlling processes • Project management functions • Performed throughout the project’s life cycle

20. Project Plan Outline • Project charter, scope, or deliverables • Description of project approach • Work breakdown structure • Cost estimates • Start dates • Controls • Performance measurement baselines • Major milestones and target dates • Risks, constraints, assumptions, and responses to each • Open issues • Supporting detail

21. Supporting Detail • Project planning software • Gantt chart • Project Evaluation and Review Technology (PERT) • Critical path • Slack • CQI techniques • Balanced scorecards • Key performance indicators • Dashboards

22. Gantt Chart Row Numbers Duration of Major Task (Activity) Builds List of Resources Task End Task Numbers Task Start Dependency Task Progress Milestone (Task = 0 Days) Note Task Completed Today

23. Change Management • Movement of organization from current state to future, more effective state • Classic change management strategies:

24. Positive influences Educating and communicating Supporting learning new skills and undertaking new tasks Providing emotional support Classic change management strategies (still widely used!) Potentially less successful change tactics: Offering incentives to accept change Using disincentives, manipulation, or coercion Ignoring impact of change and establishing expectations that change will occur over time no matter what Change Management Principles

25. Reactions to change Active support Accept/modify Acquiescence Passive resistance Active resistance Leave taker

26. Clinical transformation Integration of enabling technology throughout the redesign process Untethering of information for use when and where needed Evidence based Sustained organizational and cultural change Transfer of knowledge and effective communications Core values for performance excellence Voluntary leadership Patient focused excellence Organizational and personal learning Valuing staff and partners Agility Focus on the future Managing for innovation Management by fact Social responsibility and community health Focus on results and creating value Systems perspective Clinical and Cultural Transformation

27. IT Professionals Understand and are able to evaluate technical capability of both current and proposed systems Challenge is to include significantly more outreach and work effectively with end users e-HIM Professionals Perform data analysis Ensure data quality Support operations Manage data flow Oversee data sets Serve as data brokers Informatics American Medical Informatics Association (AMIA) defines medical informatics as a discipline having “to do with all aspects of understanding and promoting the effective organization, analysis, management, and use of information in health care.” Roles of Participants

28. Conclusion • EHR project management is a critical function and an exciting opportunity • Yet is not for everyone • Those who choose not to be a project manager are valued as: • Steering committee members • Domain team leaders • Department directors and managers • Trainers • Compliance officers • All e-HIM roles