1. Introduction to Project Management
Project Closure and Transition
Welcome to Project Management: Project Closure and Transition. This is Lecture b.
Lecture b
This material (Comp19_Unit11b) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

2. Project Closure and Transition Learning Objectives—Lecture b
Bring project activities to a close.
Conclude the customer acceptance process.
Document and archive lessons learned.
Update and close out project documents.
Manage transition to operations.
The Objectives for Project Closure and Transition are to:
Bring project activities to a close.
Conclude the customer acceptance process.
Document and archive lessons learned.
Update and close out project documents.
Manage transition to operations.
This lecture will focus on the last three objectives.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

3. Products for Transitioning
Complete Health IT Systems
Integrated hardware-software systems
May be based upon procured products
Application or Service
Executes on existing computing infrastructure
Process
New operational workflow enabled by IT
Here are some examples of the kinds of products that might arise from your project; they will be the elements we talked about in terms of transitions. There is quite a possible range. For example it could be:
Complete health IT systems—integrated hardware and software systems that are planned for use in some operational environment
An application or service that runs on existing computing infrastructure
A new process –for example a new operational workflow enabled by IT
The transition steps depend on the kind of product being transitioned and the setting the system will be implemented in. Nothing works in a vacuum and it is important to appreciate both the kind of product you have and the nature of the operational environment.
An example of complete healthcare IT system is the Electronic Medical Record (EMR) system, for example, in a physician’s office. More than likely both hardware and software will need to be purchased for this type of project.
An example of an application or service running on existing infrastructure is an example from our ePrescribing scenario that provided for writing prescriptions and having software support for writing prescriptions and processing prescriptions for all the parties. This might be an extension of the current software with an additional module.
An example of a new process / workflow enabled by IT is the implementation of a new clinical research tracking system. A paper tracking system was in place, but with a new system you are moving on to a computerized integrated tracking system.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

4. Activities to Support Transition to Operations
Training of staff
May involve several departments and interfacing organizations
Newly designed workflow and operational procedures
Documentation
New maintenance procedures
“Help,” facility for staff
There are several activities involved that will help you as you transition to operation. Make sure that the training on the new health IT system, service. or process is done well, that there is sufficient and effective documentation, and there is effective specification of any of the new operational procedures that arise. It is also important to have an ongoing “help” facility, especially online with easy access.
The quality of these activities can go a long way in determining the overall success of your project. Even if the system itself is of high quality and has all the needed functionality, if staff are not well trained in how to use it, and they don’t have a strong confidence on how to use it, it can be very detrimental to smooth transition. We need effective documentation and help support.
Don’t lose sight of all these critical supporting activities to ensure a smooth transition.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

5. Transition Approaches: Cut Over
What is it?
Switch to new system in one step
Advantages:
Simple —gets new system in operation
Once the new system is in place, staff is motivated to work out the, “bugs”
Disadvantages:
Can be a disaster if not well planned and executed
There are several different options in terms of transition approaches that we summarize here.
One approach is a cut-over activity. it is just what the name suggests—you have a date and time when you “pull the plug” on the old system and switch to the new system. Most knowledge workers are familiar with cut over in simple ways, such as when they upgrade to new versions of software. Cut over has advantages because it is so simple, but as you may expect for custom health IT systems, it is typically is only feasible when there has been extensive preparation and the systems in question are low-risk and straightforward.
Preparing for a successful cut over often includes having simulated what the operation will look like when the new system is in place—especially to ensure that the performance of the new system will be satisfactory. Of course, there is always an issue with simulation so there can still be risk.
But most important to a successful cut over is having a test environment that effectively mimics the operational environment. This way new systems can be tested thoroughly against workloads that are representative of operational use.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

6. Transition Approaches: Parallel Operation
What is it?
Run the new health IT system in parallel with the current system
Advantages:
You still have the current system in place
You can decide when to switch to new system
Disadvantages:
Can be expensive—and challenging for staff—to have both systems in operation
A second transition approach is parallel operation. With a parallel strategy, you introduce the new system without taking the old system out of service. As the name implies, in this way you can decide if and when the new system is operating effectively. Can the new system handle the volume? Can it handle the response time requirements? Does all the intended functionality work as intended on the new system? By having the current system still running, it makes it easier to compare the deliverables and performance of the new system side-by-side with the current system. Then you can “turn off” or “wind down” the current system, leaving only the new system to operate. One major source of transition risk is mitigated because the new system will be running in the true operational environment.
There are disadvantages as the parallel operation can be expensive. It also can stretch out the time period for moving to the new system by having a very drawn-out process of transition—all the while keep in mind this is placing a double load on the computing infrastructure.
The staff may be challenged in determining how to do their work when they have both systems are in operation. So careful planning and training is needed for the staff.
When you have confidence in the new system, and the feedback from the staff members tells you that the new system is working well, then you can plan to phase- out the current system—typically in stages—until only the new system remains in operation. and now you have successfully transitioned to the new system.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

7. Transition Approaches: Phased Strategy
What is it?
Switch to new system in phases
Advantages:
Organization can ease into use of new system
Can stretch out phases over time to match flow of funding
Disadvantages:
Requires breaking system into phases
Delays implementation of full system
A third transition approach is a phased strategy. This strategy is often preferable to the other two we discussed. With a phased approach, you can gain confidence with a portion of the system and then move on to the next part of the system, gradually placing the system in operation in phases. Such a plan requires careful consideration about the best ways to break apart the system into portions—it may be by logical function or by work flow, or by organizational unit, or some combination. Because each phase requires fitting in with the current system as it is evolving there can be considerable integration effort required when you have these kinds of phase strategies.
But it may be the only way to proceed if there are resource constraints—such as the funds that may be available and availability of staff members to introduce new functions. The funding and staff may be appropriate for transitioning a phase at a time—but not enough for an implementation of the entire system at one time.
One suggestion is to follow the patient flow. If the patient is admitted into certain units or areas and discharged from other areas, then those areas should come up together. That way one unit does not have to deal with working in both systems. An example is that you may want all of your surgical areas, both pre- and post-surgical units to go live on the system at the same time.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

8. ePrescribing Project: What Transition Strategy to Use?
Project Summary: Providers of an outpatient clinical facility are requesting an upgrade to the current ordering system to include the latest feature of ePrescribing. All providers will use this system for writing patient prescriptions and sending the prescriptions to any of 50,000 regional pharmacies depending on patient requests.
Features of the system: Features should include, but are not limited to, ability to, “write,” prescriptions based on the local formulary of medications, print or transfer prescription either by fax or electronic ally to the pharmacy of patient’s choice, ability to store a medication history for each patient, up-coming needs for prescriptions, workflow allowing ancillary personnel to take a phone request for a new / refill medication for the prescriber to approve before being sent to the pharmacy, upload of 3rd party information about regional pharmacies, and real time insurance verification for allowed medications based on insurance coverage.
As an example to explore different transition strategies, consider this example of the e-prescribing project. Providers of an outpatient clinical facility are requesting an upgrade to the current ordering system so that the facility will include the latest feature of ePrescribing. All providers will use the system for writing patient prescriptions and sending the prescriptions to any of the 50,000 regional pharmacies depending on the patient’s request.
There are a number of features of this system that are critical in terms of writing prescriptions based on the local formulary of medications, the ability to print or transfer prescriptions either by fax or electronically to pharmacies of the patient’s choice. The system needs to have the ability to store medication history for each patient and deal with the upcoming needs for prescriptions, and handle the work flow affecting ancillary personnel; for example, taking phone requests for new medications or refills for the prescriber.
Based on the options we talked about in terms of cut over, parallel operation, and phase strategies, consider this example and discus the possibilities in terms of transition strategies that make the most sense for the e-prescribing project. What would be the pros and cons of each one? Keep in mind that the three strategies can be used in various combinations, so you are not limited to just choosing exactly one of the three. Let’s look at some of the alternatives.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

9. ePrescribing Project: Possible Transition Strategies
Cut Over—high risk with such a multi-function system that involves external stakeholders (physicians, pharmacies, and insurers) and patient care
Parallel—possible, but expensive
Phased—provides flexibility to stage the implementation, adding features over time
Each alternative has pros and cons. The transition must be handled carefully, after all patients are counting on getting their prescriptions filled accurately and on time. The system interacts with many physicians and many pharmacies as well as patients, so this transition must go smoothly.
Choosing a cut over could carry high risks when it is a multifunction system that involves external stakeholders and patient care. A parallel operation can be very expensive to run, and difficult to coordinate the staff in how to make it work effectively.
A phased approach would provide a lot of flexibility to stage the implementation, adding features over time. this is probably the best bet based on the information we have about the prescribing system because of its multifunction nature.
Remember, for example, that phased approaches can be used in various combinations.
In a phased approach, start with having the meds the patient is currently on put into the system over a matter of weeks or months. The next phase could be having the prescriber print the new medications or changing medications out of the system and giving the patient a written prescription or a printed prescription. The last part of the project could be phasing in the e-prescribing where the physician sends the prescription electronically to a regional pharmacy. That is one approach that could be taken in a phased way.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

10. ePrescribing Project: Phasing Options
If a phased approach is used, what are the alternatives for grouping system features into phases?
Back-end capabilities? e.g., storing medical histories for patients or providing real-time insurance verification for allowed medications based on insurance coverage
Primary system capabilities? e.g., capability to, “write,” prescriptions based on the local formulary of medications
Talking about options raises the question of how to partition the system into phases. It could include consideration of the backend capabilities and that sorting the medical history for patients or providing real-time insurance verification might be separate activities.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

11. Techniques for Smooth System Transitions: Simulation
Develop a simulation model:
Simulate the operation of the new system in the computing and workflow environment of the organization
Experiment with the simulation model to gain confidence in the new system
Simulation runs will help ensure that the new system will meet performance and responsiveness requirements of users
One technique to help ensure a smooth transition is simulation. The idea is to have a simulation that allows you to experiment with the effects of the new system and processes and determine its ability to handle the volume of performance requirements. If you’re doing a simulation, be sure to involve the end users when you can.
Many institutions have developed simulation labs where end users can go to simulate new processes in an environment that mimics the work environment. If the institution that you are working with has one of these labs, use it. If they do not, consider creating your own such environment. Use a room or area where you can bring staff to help them visualize the new work environment. Get actual patient charts or orders and have the staff begin to simulate working in the system. Hand out packets of scenarios that will take the staff five minutes to work through. These exercises will help the staff in transitioning to the new reality.
These simulation runs will help give you confidence that the new system will meet the performance requirements of users.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

12. Techniques for Smooth System Transitions: Test Environment
Create a test environment of computing hardware and software
Implement the new systems, processes, and services in the test environment
Bring in staff members to try out the new system in the test environment
Obtain their feedback on how the new system is working and what changes should be made
Another example of a technique for smooth system transition is to provide a test environment. The test environment for computing hardware and software provides a place to implement the new systems, processes, and services. You can gain confidence about the operation of these new elements.
This is an excellent opportunity to bring in staff members to test the system in a test environment before they try it out in the operational environment. Especially important is to obtain feedback as they work in the test environment on how the new system seems to be working and what changes need to be made.
One way to handle this is to insert instrumentation in the test environment so you will get metrics on how the system is performing. The use of this environment can be effective in terms of getting some quantitative information about response time and performance and how the users are interacting with the system.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

13. Techniques For Smooth System Transitions: Gap Analysis
Prepare an “as-is” model of how your current system operates
Use diagrams and supporting text to describe the workflow and use of IT systems
Prepare a, “to-be,” model
How will work be done with the new system?
Conduct a gap analysis
Compare the, “as-is,” and, “to-be,” models so you can plan to, “bridge the gap”
Another transition technique is gap analysis. Gap analysis starts with preparing an “as-is” representation of current processes, workflow, and systems that will be affected by the products of your project. This is your way to represent the current environment. Consider using graphical depictions that show the flow of information and the flow of the work being done by organizations and IT systems and what their roles are in the current system.
You can use scenarios developed in the requirements specification as a starting point and use these to define the “to-be” operations. In this technique we are contrasting the “as is,” or current operations with the “to be” operations, that is those that are associating with the new system and workflow and processes. For both “as-is” and “to-be” representations, consider using already-established modeling technologies. There are flow charts and simple graphical techniques that are used, but there are also more representative models available, such as the UML, the Unified Modeling Language. This can be an effective technique for you to capture the “as-is” and “to be” representations.
As the name gap analysis suggests, the purpose of the gap analysis is to compare and contrast these two representations— the “as is” and “to be” representations. For example, in a gap analysis you can help to address questions such as:
How will you get from “as-is” to “to-be” systems?
What steps will you take? In what order?
What does that imply for the training that will be needed for the staff?
What stakeholders must be notified and involved to have a successful implementation?
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

14. Project Closure and Transition Summary—Lecture b
This lecture stressed the importance of effective project close-out and transition:
What is needed to bring project activities to a successful close.
How to conclude procurements and the all-important customer acceptance process.
The value of documenting the project and archiving lessons learned.
Techniques such as phased strategies for transitioning to your new health IT system.
This concludes Lecture b of Project Closure and Transition. In summary, this unit stressed the importance of effective project close-out and transition activities. Questions to ask include: What is needed for you as a project manager to bring these project activities to a successful close? How to conclude the customer acceptance process and procurements? How to ensure that your customer signs off on your project and deliverables and is satisfied with the outcome of your project? How to address the importance of documenting the project? How to ensure that appropriate documentation occurs?
We discussed techniques that are useful for transition to operations such as simulation, gap analysis, and test environments. These can be very effective to get the products of your system of your project into operational use in your health IT environment.
You want to conclude your health IT project on a high note! You want your stakeholders to remember your project as a success that brought valuable capabilities to your organization! By using the techniques discussed in this unit, you can help to ensure that you will bring your project to a successful conclusion.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b

15. Project Closure and Transition References—Lecture b
Fleming Q. (2003).Project procurement management: contracting, subcontracting, teaming. 1st ed. FMC Press.
Health Information and Management System Society. Chicago, IL Available from:
Houston S, Bove LA. (2010). Project management for healthcare informatics. Springer Science + Business Media, LLC;
Kerzner H. (2009).Project management: a systems approach to planning, scheduling, and controlling. 10th ed. New York: Wiley.
Liebowitz J. (1999) Key ingredients to the success of an organization’s knowledge management strategy. Knowledge and process management. (6:1), pp
Project Management Institute, A guide to the project management body of knowledge. 4th ed. (2008) Newtown Square, PA: PMI.
Schwalbe K. (2009). Information technology project management (with Microsoft Project 2007 CD-ROM). 6th ed.
Stackpole C. (2010). A User’s Manual to the PMBOK Guide. Wiley.
Stackpole C. (2009). A project manager’s book of forms: a companion to the PMBOK guide. New York: Wiley.
Wysocki, RK . (2009). Effective project management: traditional, agile, extreme. 5th Edition. New York: Wiley.
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Health IT Workforce Curriculum Version 3.0/Spring 2012
Introduction to Project Management Project Closure and Transition Lecture b