1. EHR Project Management: Roles in Design and Implementation
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 Management Resources
Example
Project Sponsor
Project Manager
CIO
Vendor
Nursing
Medical Staff
Ancillaries
HIM
PFS
Steering
Committee
Documentation
Pharmacy
RCM
Ambulatory
MAR
Orders
Domain Teams
Consultants
Temporary Staff

10. EHR Steering Committee

11. EHR Project Manager Tasks Qualifications 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. while keeping back end in view
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. Project Management Standards
Integration management
Planning
Change control
Scope management
Authorization
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
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 CQI techniques Gantt chart
Project Evaluation and Review Technology (PERT)
Critical path
Slack
CQI techniques
Balanced scorecards
Key performance indicators
Dashboards

22. Builds List of Resources
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. Change Management Principles
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

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

26. Clinical and Cultural Transformation
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

27. Roles of Participants IT Professionals e-HIM Professionals Informatics
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.”

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