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

2. First, a Little Background

3. 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

4. Who does VITL serve?
REC providing services to 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

5. 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.

6. “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)

9. 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.)

10. 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

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

12. 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

13. 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.

14. 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

16. Timeline

17. Mission Accomplished!

18. 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”

19. 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

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

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

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

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

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

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

26. Questions?