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Learn one

Do one 

      
  • See an example of high level milestones for implementation of VistA.  This file requires access to Microsoft Project 
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Implementation of
Electronic Health Record

What will it take to successfully complete information system projects on time and under budget?  Much more than comes to mind at first.  This section provides readings for how to implement information systems. 

Learn One:  Project Management

  1. Read Weaver P.  A brief history of scheduling:  Back to the future, 2006.  More►
  2. Read Weaver, P.  The Origins of Modern Project Management, 2007.  More►
  3. Read the Wikipedia site for a quick introduction to Project management  More► 

Phases of Project Management

The implementation of Electronic Health Records (EHR) can be broken into the five broad phases:  initiate, plan, execute and control.  Each of these phases are further explained using an outline provided by Claudine Beron:

  1. Initiate
    This phase marks the beginning of the project or phase and formally authorizes the project. For a successful project, the objectives and requirements should be well defined at the start of the project.
    • Educate Your Organization on EHR
    • Identify Owners & Stakeholders and get buy-in
    • Identify Subject Matter Experts in each area considered
    • Understand the Environment Today (high level only)
    • Description of organization by Bed#, Acute / Long Term / etc and types of patients
    • Services provided today (note difference if more than one environment)
    • Legacy Systems in place?
      • Which one’s Interfaces (HL-7 ver 2.0?, NCPDP, etc)
      • Quality of Data, if any # of
    • Clinical and IT Staff
    • Outside of the Project Team Skills that will be needed
    • Develop Business Case that include preliminary scope requirements
    • Understand Budget Cycle and Politics
    • Understand Procurement Process (if vendors are used)
  2. Plan
    The Planning Process Group is considered the most important Process Group in project management. Time spent up front identifying the proper needs and structure for organizing and managing a project saves countless hours of confusion and rework during the Executing and Monitoring and Controlling Process Groups. Project planning defines project activities that will be performed, the products that will be produced, and describes how these activities will be accomplished and managed. Project planning defines each major task, estimates the time, resources and cost required, and provides a framework for management review and control. Planning involves identifying and documenting scope, tasks, schedules, cost, risk, quality, and staffing needs. This planning process includes the following:
    • On Site Assessment of the Environment
    • Detail questions/interviews for each clinical area to implemented modules based on preliminary scope
    • Develop Gap analysis of actual systems and resources
    • Build Draft Project Plan/WBS & Schedule
    • Confirm Scope requirements
    • Prepare Budget and Resource needs assessment
    • Develop Request for Proposal (RFP) for Vendor Services, if applicable
    • Evaluate Proposals for winning bid with lead clinical staff included Validate start date and terms and conditions
    • Select Vendor and approve start date
    • Update Schedule and Project Plan/WBS
    • Verify Staffing by Organization and Assignments
    • Verify Training by Organization and Assignment
    • Order Hardware/Software for Test/Development and Production Site(s)
    • Start up meeting to bring all stakeholders together
  3. Execute
    The Project Team and all necessary resources should be in place and ready to perform project activities. The Project Management Plan is completed and baselined by this time as well. The Project Team’s and specifically the Project Manager’s focus now shifts from planning the project efforts to participating in, observing, and analyzing the work being done. In this phase the work activities of the Project Management Plan are executed, resulting in the completion of the project deliverables and achievement of the project objectives. This Process Group brings together all of the project management disciplines, resulting in a product or service that will meet the project deliverable requirements and the customers need. In this Process Group, elements completed in the Planning Process Group are implemented, time is expended, and money is spent. This Process Group requires the Project Manager and Project Team to:
     
    1. Conduct, coordinate and manage the ongoing work activities
    2. Perform quality assurance activities continuously to ensure project objectives are being met or achieved
    3. Monitor identified risks for triggering events and implement containment or contingency strategies as necessary
    4. Distribute information to project stakeholders
    5. Manage change.

    In short, it means coordinating and managing the project resources while executing the Project Management Plan, performing the planned project activities, and ensuring they are completed efficiently.  These activities include:
     

    • Build Test/Development System
    • Include staff responsible for ongoing maintenance for training
    • Document System (Build Guide, Configuration Guide)
    • Test System prior to implementing EHR
    • Load EHR and Configure Modules mapped to current services Foundation (Foundation, FileMan, HL7, Kernel, all mandatory) Basic (Lab, Pharmacy, Scheduling, etc)
    • Standard (CPRS, Problem List, etc) Extended (Hepatitis C, Medical Clinical Services, etc)
    • Include staff identified as subject matter experts to validate configuration of modules and training
    • Test System prior to ghosting to Production System
    • Provide 1st Round training while system is Test/Development
    • Verify configuration and usability by end users at Pilot Site
    • Deploy Pilot Site (Production Site)
    • Train SMEs and End-Users at Pilot Site
    • Evaluation of course material essential
    • Obtain Site Completion Sign off by owner
    • Deploy Disaster Recovery Site
    • Include staff responsible for ongoing maintenance Deploy and Test at Additional Sites
    • Validate any differences in site by site services
    • Train SMEs and End-Users
    • Obtain Site Completion
    • Sign off by owner Implement and Support.
       
  4. Control
    Project performance must be monitored and measured regularly to identify variances from the project plan. Occasionally, current projects of the on-line era, also demand a change in an objective or a deliverable. Hence the methodology is equipped with a flexible yet well-defined process to control and manage the changes being requested to the project scope and objectives, and allows revisiting of the above phases anytime during the project life cycle.  Some of the main processes that can occur during this phase are:
    1. Scope Change
    2. Control Risk Monitoring and control
    3. Cost control
    4. Performance Reporting

    Specific activities may include:
     

    • Control Validate throughout the project that scope is aligned with deliverables
    • Changes documented in Change Request with owners signature
    • Risk Monitoring and Control
    • Develop Risk and Issue logs
    • Meet on weekly basis with team/owners to document and discuss mitigation strategies
    • Engage now owners if mitigation strategies aren’t working – don’t wait
    • Cost control Review and document with team hours allotted and scope of work to be done
    • Manage weekly/bi-weekly/monthly timesheet reporting
    • Manage subcontractors, if any to their contracts
    • Manage weekly/bi-weekly/monthly timesheet reporting
    • Manage ODC’s and document any discrepancies in estimated .vs. actual cost
    • Report to owner when 75% of project is complete
    • Performance Reporting
    • Provide monthly reports on financials and milestone/deliverables completed based on schedule and project plan.
       
  5. Close
    The last major Process Group of a project’s life cycle is the project Closing Process Group. Project closeout is performed after all defined project objectives have been met and the customer has formally accepted the project’s deliverables and end product or, in some instances, when a project has been cancelled or terminated early. Project closeout is fairly routine, but it is an important process. By properly completing the project closeout, organizations can benefit from lessons learned and information compiled at closure.  Activities include:
     
    • Complete closeout of any contracts subcontractors/product vendors
    • Document licensing and warrantee for systems
    • Sign off of customer acceptance
    • Attach site completion sign off’s
    • Closeout of any financial matters
    • Prepare final reports
    • Conduct a project review with all stakeholders
    • Document lessons learned
    • Complete, collect and archive project records
    • Celebrate!

What you know?

Advanced learners like you, often need different ways of understanding a topic. Reading is just one way of understanding. Another way is through writing about what you have read.  The enclosed assessment is designed to get you to think more about the concepts taught in this session. 

  1. Who was Gantt and what did he contribute to scheduling activities?
  2. Which organization developed the critical path method and why?
  3. What do the initials PMI stand for and what is the name of the book it created?
  4. What makes 21st century project management different from management of historic projects such as the Pyramids?
  5. What are the five phases of project management
  6. What happens in the closing phase of project management?

  7. Given the following information, calculate the earned value, cost variance, schedule variance, and cost performance index for weeks one and two.  Calculate the Estimate to Completion.  Make a plot of planned, actual and earned values.  Show the Estimate At Completion on the plot.  See a guide on how to do this assignment.  Video► SWF►
     

      Week
    One    		 Week Two Other Weeks  Week Ten
    (Project End)
    Rate of performance 50% 75%    
    Planned value $7,000 $27,000   $100,000
    Actual cost $8,000 $29,000

  8.  Calculate rate of performance and visually show progress made in the following project:  Here is a just in time advice on how to solve this problem.  Video► SWF►  You Tube►

    Code

    Description
    of Activity

    		 Immediate
    Precedence    		 Pessimistic Realistic Optimistic Start
    (Month/date)    		 End
    (Month/Date)
    1 Strategic plan phase   9 months 8 months 6 months 1/1 6/1/
    2 Project initiation phase 1 Depends on duration of sub-tasks    
    2.1.    Team formation   3 months 2 months 1 month 7/1 11/1
    2.2.    Master facility plan 2.1 8 months 7 months 6 months 11/2 12/30
    2.3.    Space programming Finish with 2.2 9 months 7 months 6 months    
    2.4.    Land acquisition analysis 2.2 6 months 4 months 3 months    
    2.5.    Project budget & schedule 2.2 5 months 2 months 1 months    
    2.6.    Joint venture analysis 2.1 5 months 2 months 1 months    
    3 Building design 1, 2 Depends on duration of sub-tasks    
    3.1.    Facility design   9 months 7 months 6 months    
    3.2.    Equipment planning 3.1 6 months 4 months 3 months    
    3.3.    Regulatory approvals 3.2 4 months 2 months 1 month    
    4 Construction phase 3 9 months 6 months 5 months    
    5 Occupancy 4 3 months 2 months 1 month    

  9. Given the following table of activities and precedents, calculate rate of performance and the budget/schedule overrun at end of the project.  To obtain planned project duration, please use your software for Project Management, put in the tasks, put in the duration of tasks, put in the precedence for each task and note when the project ends.  Keep in mind that sufficient information may not be available to answer all portions of this question. Video►   You Tube►
     

    Activity

    Description
    of Activity

    		 Immediate Precedence Planned
    Duration    		 Completion
    Duration    		 Planned
    Expenditure
    A Obtain list of patients   2 weeks 4 weeks $1000
    B Sample patients A 1 week 2 weeks $500
    C Print survey tool   3 weeks 3 weeks $13,000
    D Mail survey tool B, C 4 weeks   $2,000
    E Collect early responses D 1 week   $3,000
    F Collect late responses E 3 weeks   $9,000
    G Analyze data E 2 weeks   $2,000
    H Report findings F, G 1 week   $1,000

Presentations

2007 Microsoft Project videos

2003 version of Microsoft Project videos

Do One:  Plan an EHR Implementation

You must complete this project by yourself.  In this project you are asked to plan implementation of an electronic health record in an organizations using the the work break down tasks described below: 

  1. Patient Information Management
    1. Admission, Discharge, and Transfer (requires subtask B, configuration lasts 30 days, training lasts 5 days) 
    2. Patient Registration (requires subtask C, configuration lasts 3 days, training lasts 5 days)
    3. Enterprise Master Patient Index (configuration lasts 3 days)
    4. Patient Scheduling (requires subtask B, configuration lasts 10 days, training lasts 5 days)
  2. Clinical Information System (requires implementation of tasks 1, 3-7)
    1. Clinical Alerts and Reminders (requires subtask B, D, E, G, configuration lasts 30 days, training lasts 5 days)
    2. Clinical Rules Engine (configuration lasts 10 days)
    3. Consults Tracking (requires subtask G, configuration lasts 3 days)
    4. Order Management (requires subtask H, configuration lasts 30 days, training lasts 5 days)
    5. Results Reporting (requires subtask D, configuration lasts 3 days, training lasts 5 days)
    6. Clinical Documentation (requires subtask E, configuration lasts 3 days, training lasts 5 days)
    7. Computerized Provider Order Entry (requires subtasks F, H, I, J, configuration lasts 45 days, training lasts 15 days)
    8. Intake/Output (configuration lasts 3 days, training lasts 5 days)
    9. Patient Education (configuration lasts 3 days, training lasts 5 days)
    10. Vitals/Measurements (requires subtask H, configuration lasts 3 days, training lasts 1 day)
  3. Laboratory (requires implementation of task 1)
    1. Anatomic Pathology (requires subtasks B and C, configuration lasts 10 days, training lasts 5 days)
    2. Microbiology (requires subtask C, configuration lasts 10 days, training lasts 5 days)
    3. Chemistry (configuration lasts 10 days, training lasts 2 days)
  4. Pharmacy  (requires implementation of task 3)
    1. Adverse Reaction Tracking (requires subtasks B, C, D, configuration lasts 10 days, training lasts 5 days)
    2. Electronic Medication Administration Record (requires subtask D, configuration lasts 10 days, training lasts 5 days)
    3. Bar Code Medication Administration (requires subtask B, configuration lasts 30 days, training lasts 15 days)
    4. Inpatient/Outpatient Pharmacy (configuration lasts 3 days, training lasts 5 days)
  5. Radiology  (requires implementation of task 1)
    1. General Radiology (configuration lasts 30 days, training lasts 5 days)
    2. Nuclear Medicine (configuration lasts 30 days, training lasts 5 days)
  6. Imaging  (requires implementation of task 5)
    1. Clinical Image Viewer (configuration lasts 3 days, training lasts 2 days)
    2. Document Imaging (requires subtask A, configuration lasts 3 days, training lasts 5 days)
  7. Nutrition and Food Service (requires implementation of task 1)
    1. Clinical Nutrition (requires subtask B, configuration lasts 3 days, training lasts 5 days)
    2. Food Service Management (configuration lasts 3 days, training lasts 5 days)

Confusing Project?

Ask a question about the project and we will answer it within 24 hours below as well as email the answer to you.  

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Your question:

You may make changes in the required tasks, if it makes sense to you and if you can present the logic behind the changes you are making.  Please develop a MS Project Plan/Schedule that will utilize the work breakdown described above.  Prepare a narrated report of your project containing the following slides:

  1. The project mission statement.
  2. Project Work Breakdown Structure showing high-level tasks, start time and finish time.  Please make sure that this information can be read clearly.  If your data depends on a series of additional assumption, please clarify these assumptions.
  3. Project sub-tasks.  Add additional slides if necessary.   When narrating be brief and no more than 1 minute per slide.  Make sure that we can see and read the information on each of the sub-tasks.  Make sure that you comment on the dependencies in the sub-tasks.
  4. Control system for checking and adjusting project plan.   Show how you would enter that a task is done ahead of schedule and what will be the consequence of such information.  Do this for one task.  Make sure that the impact on the end of project or on additional project tasks are clearly documented and shown.
  5. Introspection slide (what did you learn from this exercise).  Talk specifically about what you have learned regarding project management.  Do not talk about the specific project you just completed, talk about the broader issues of using a tool (such as Microsoft Project) to manage projects.

See an example of high level milestones for implementation of VistA (requires Microsoft Project).  This file can be opened with Microsoft Project software.  A narrated slide presentation should be used to present the plan.  Please post your work to a public environment such as U-tube.  Once you have completed your work please seek the work of others.  Here are some examples:

Seek the work of other students and comment on their work using the following rubric:

  • Comment on your colleague's presentation (please make a comment in all five areas):
    1. Start with what worked well.
    2. Were the slides requested present?  If there were more or less than the expected slides were the slides presented all necessary? 
    3. Was the narration clear?  Was the sound quality reasonable?  Were the graphics self-contained and informative.  Would one have understood the graphs and the bulleted points, if the narration was not present?  Was any of the necessary text so small that one could not see it.  Was the use of color and animation judicious and able to highlight major points?
  • Comment on the content (you are required to make one comment in all eight areas):
    1. Start with what worked well? Go ahead with your praise but give details so that one can understand why you were so impressed.
    2. Did the project include various dependencies among the tasks?
    3. Was the project task duration correct? Was the total length of project same as your calculated length and why was there a difference?
    4. Did the project clarify its assumptions, specially the assumptions they had made beyond what was presented in the assignment.
    5. Did the project clearly show the consequences of changing the finish time of one of the activities? 
    6. Did the project provide introspections about project management?  Note that students are expected to discuss the method of project management and not the particular schedule they had analyzed. 
  • Comment on what you have learned about your own project from contrasting your work with the project you have reviewed.

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