Just In Time Project Management: Electronic Health Record in 8 Weeks Carol Kulczyk, PMP VITL Director of Program Implementation

First, a Little Background

About VITL Established by the VT Hospital Ass’n in 2005 Now independent 501(c)(3) Designated the statewide Health Information Exchange (HIE) in 2007 Supported by state HIT Fund since 2008 Supported pilot EHR deployments Received Regional Extension Center (REC) federal grant from ONC in Feb 2010

Who does VITL serve? REC providing services to 1100 Primary Care Providers (PCPs) associated with: 300+ Independent Practices 14 Hospitals including eight Critical Access Hospitals 8 FQHCs 14 Rural Clinics 11 Free Care Clinics 756 PCP’s currently enrolled in REC program

Average EHR project duration: 9 months. VITL REC Services Assisting PCPs to achieve meaningful use by providing: Interoperability and Health Information Exchange Privacy and Security Guidance Education and Outreach Local Workforce Support Participation with National Learning Consortium Vendor Selection and Preferred Vendor Program Implementation and Project Management Support Practice and Workflow Redesign Preparation for Meaningful Use attestation Average EHR project duration: 9 months.

“Your Mission, Should You Show Choose” Implement an EHR in eight weeks And a Practice Management System ! Background Solo Practitioner Newbury, Vermont Family Medicine with OB/GYN ~1000 patients April, 2010 – Requested assistance from VITL to implement an EHR June, 2010 – Leaving existing practice; opening her new practice (renovating facility while implementing EHR & PMS)

Optimal Project Environment Adequate time Adequate funds and resources Fixed scope Strong project team Solid project sponsor / advocate PMI (or other) structure for success (scope, schedule, budget, etc.)

With Less Than Optimal Project Environment Challenge: How to succeed when Project Management Institute (PMBOK) best practices and steps could not all be completed Approach: Complete the tasks that promised the maximum benefit to the long term success of the project, while applying a high standard of quality and applying a minimum of effort

Just In Time Project Management Methodology derived from project survival 3 Stages Scope Control Manage (why is this last?)

Stage 1 - Scope Scope definition Budget refinement Staffing Clearly defined deliverables Scope creep is verboten Budget refinement Make sure the budget parameters are clearly defined Costs for training and support should be backended Staffing Highly experienced and fully dedicated to the project Learning curve needed to be vertical

Stage 2 - Control Tasks and issues management Critical path tracking “One throat to choke” assignment of tasks, with clear deliverables and deadlines. Critical path tracking Develop contingency plans at the outset, not when the catastrophe occurs. Project risk management Focus on the risks and mitigate them. Don’t focus on project progress.

Stage 3 - Manage Project plan development Communication Due diligence Build project plan at level of minimal detail Communication Expectation management Due diligence Confirm product functionality Quality and change management Insure coordinated changes and revisions as necessary

Timeline

Mission Accomplished!

Project Lessons Learned Vendor selection Due diligence required Application configuration OK to challenge vendor’s typical methodology E.g. Parallel clinical and collection tracks Training Effective remotely in certain circumstances Plan multiple “dress rehearsals”

Project Lessons Learned (continued) Resource management Expect need for pinch hitter(s) Vendor management Need expedient response from vendor (“hotline mentality”) Issue resolution Daily “stand up” meetings A decisive project sponsor is critical Medical Assistant called to jury duty 2 weeks prior to go-live; Insurance and Billing person unavailable during implementation

Project Lessons Learned (continued) Project planning and execution Be open minded to alternative approaches Flexibility is key Brace yourself and enjoy the ride

What Works Focusing on critical activity Frequent communication Decisive leadership Scope control Focus on goal, not on the plan

What Doesn’t Work Rigid project plan Scope creep Diluted decision making Applying all project management best practices and tools

Learning Objective - Lean Scope the project Control the project Manage the project

Learning Objective - Critical to Success Only value add Add value when needed - remove non-value added Do what is necessary, not what is planned

Learning Objective – Overcome Obstacles Effective and expedient issue resolution Stakeholder and vendor buy in Rapid course correction Emotional support

Questions?