Section 2.4 Plan

Project ManagementThis tool lists the general functions a project manager is expected to perform, including project oversight and documentation.

Time needed: 4 – 6 hoursSuggested other tools: 2.2 Communication Plan, 2.3 Visioning, Goal Setting, and Strategic Planning for EHR and HIE

HIT Project Management For a local public health (LPH) department implementing electronic health record (EHR), health information exchange (HIE), or other health information technology (HIT), individuals are likely to wear many hats in support of the HIT initiative. Whether a person is assigned as a full- time project manager, spends part of the time on IT and part on project management, or is a consultant is brought on board for the project, the role of the project manager is essential. This tool lists the general functions a project manager is expected to perform, including project oversight and documentation.

How to Use1. Administrators should review project manager functions and determine who will serve as the

project manager for its EHR, HIE, and other HIT implementations.

2. Administration should review information on establishing project governance, including establishing decision-making structures and an HIT steering committee.

3. The project manager should review the tips for managing project documentation, meetings, agendas, and minutes.

Project Manager FunctionsFor any HIT (EHR, HIE, or other) project, the project manager should be someone with strong organizational skills and attention to detail to perform the following functions:

• Ensure readiness for HIT adoption– Provide for HIT education for the organization– Assess readiness – Facilitate visioning, identification of goals, strategic planning, and definition of critical

success factors, assumptions, risks, and obstacles for each project

• Organize the effort– Facilitate formation of HIT steering committee – Plan communications– Document project tasks

• Initiate change management– Oversee workflow and process mapping and redesign– Identify HIT functional requirements– Coordinate technical requirements– Plan chart conversion

• Coordinate vendor selection if applicable to your department

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– Support code of conduct– Aid in surveying the marketplace and narrowing the field of candidates

• Vendors for EHR• Vendors for HIE• Vendors for other HIT

– Coordinate RFP issuance, response, and evaluation– Coordinate due diligence activities– Assist in identifying financing

• Coordinate implementation– Establish a progress reporting system– Maintain an issues log/problem-escalation procedure– Install a change control process– Harmonize the vendor’s project plan with the organization’s needs– Develop a rollout strategy– Monitor task completion– Support system build– Oversee the training plan– Oversee the testing plan– Plan and manage go-live

Copyright © 2014, Margret\A Consulting, LLC. Used with permission of author.

Although go-live typically signals the end of a project, adopting EHR and HIE will result in an ongoing program of quality improvement and HIT enhancements. The person designated as project manager often stays with this new program to: coordinate ongoing maintenance and benefits realization; monitor and ensure adoption; optimize use of the EHR, HIE, or other HIT; and evaluate upgrades and opportunities for additional technology.

Project OversightMany organizations find themselves in analysis paralysis over HIT decisions—how they should plan strategically, which vendor to select, when to implement, and who should be involved. Frequently, this is because HIT may still be somewhat unchartered territory and definitely is expensive. Organizations are finding that creating an HIT governance structure is helpful. It provides authority at the lowest appropriate level for each type of decision to be made.

Adaptability to Various Types of OrganizationsOrganizations vary in size and nature of their governance. But all need to plan for decision making that provides authority and responsibility and that everyone understands and accepts. This expedites decision making and removes second guessing. Small LPH departments may not feel an HIT governance structure is needed. However, smaller organizations sometimes need structure the most, as they are often accustomed to decision-making by committee or unilaterally by one individual. Following is a list of many of the decision-making tasks you may encounter in HIT projects. Identify, for your organization, at what level each decision should be made. Add or delete decision-making tasks that don’t apply.

The tasks are arranged in order by the level at which they are usually made (i.e., board and executive management at the top; individual user at the bottom). In general, if a group of users will be affected by the decision, the decision should be made by the group as a whole, or representatives of the group if it is a larger organization.

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Decision-Making Task Organizational Unit to Make DecisionRelease of funds

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Decision-Making Task Organizational Unit to Make DecisionContract approvalContract negotiationBenefits expectation setting/benefits realizationProject staffing/steering committee formationCommunity engagement(HIE) trading partner communicationsContract managementCommunication planVendor selection code of conductGoal settingStrategic planning/migration pathIT acquisition strategyAcceptance testingProject management/domain team formationProject budgetFunctional requirementsHIE participationChart conversion strategyTurnover and rollout strategiesInput devicesIssues managementSuper user identificationClinical documentation standardsDesign of screensAdoption of practice guidelines/care pathsClinical work flowsCore data setsCustomization of screens and templatesClinical decision support rulesCustomizations of reportsData dictionary/master files and tablesData conversionContingency planningStaff developmentEnd user trainingData quality managementInterface testingSystem testingGo-live readinessArchive requirementsNetwork bandwidth requirementsChange controlDocument management and controlSecurity controls

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HIT Steering CommitteeSteering committees serve the following functions:

Help educate all stakeholder constituencies

Represent all stakeholder interests to ensure equality in decision-making

Provide shared decision-making so that there is buy-in for the project

Serve as a forum to arbitrate disputes or dilemmas among stakeholders

The following is a guide to the types of people who should be included on an HIT steering committee, depending on the size of the organization. For small departments, four to six people may be on the committee.

HIT Steering Committee Members PurposeChair of steering committee Individual should be able to lead the committee with an unbiased

approach and be able to devote the time to planning and attending meetings and performing follow-up activities.

At least two professional representatives Public health nurses will be the primary users of EHR and HIE. They need to fully understand and be engaged in the selection, implementation, adoption, and optimal use of the EHR and HIE. Including champions is the natural inclination. Including resisters as well helps recognize types of potential resistance and helps craft ways to overcome such resistance.

Representative(s) from administration, business office, health information management; representative from IT

While EHR and HIE are largely clinical systems, they must support charge capture, scheduling, release of information, and other administrative and financial operations of the organization. Representatives of these interests should participate on the steering committee. IT staff should be involved to understand the scope of technical support required for both implementation and ongoing maintenance.

Project manager As this individual is the central coordinating person, the project manager should be a full time member of the steering committee and be given authority to allocate other staffing resources as required and feasible for the size of the organization.

Other individuals may support the steering committee in an ad hoc manner at different points within the activities. For example:

Governing body liaison Chief financial officer Procurement specialist Legal counsel EHR/HIE consultant IT consultant External contract negotiator Trainers Human resource specialist Grant writer

Depending on the size and type of the organization, each of these individuals may play unique roles. A liaison from the governing body is necessary to gain acceptance for the project. The CFO or the chief accountant can assist in assessing financial readiness, identify financing sources, compiling the business case (return on investment), and planning pro forma financial statements in preparation for seeking a loan or responding to a grant opportunity. An EHR consultant may help navigate the many vendor choices and steps in preparedness, selection, and implementation. Sometimes a consultant is brought in to negotiate your contract from the perspective of IT service level agreements, functionality, etc. Legal counsel, however, should review the contract from a legal perspective. If you have training staff, involve them during some of the phases to assist in training. A human resource specialist can assist in developing job descriptions for new/changed positions, work with the organization to manage change for its employees, and assist in any labor relations issues. If the organization expects to seek grant funds, a grant writer will need to be included in some of the steering committee activities.

Copyright © 2014, Margret\A Consulting, LLC. Used with permission of author.

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Steering committee members: Must be given authority commensurate with their responsibilities on the committee.

Must be educated about EHR and HIE, with education a part of the formative stages of the committee’s work. It is not necessary or even desirable to seek only members who come to the committee with such knowledge.

Are expected to attend every meeting. Delegates are not acceptable.

Must represent their constituents, and hence must also have the obligation to educate them and learn of their requirements.

Are expected to work as a team with other committee members, demonstrating willingness to reach consensus.

May need release time to conduct product reviews, review proposals, etc.

Tips on Project DocumentationA key responsibility of project management is ensuring that projects are completed on time and within budget. In addition to the functions described above, documentation is a crucial ingredient in successful project management.

Project documentation:

Promotes objectivity

Avoids re-work

Helps achieve on-time, on-budget implementation

Is evidence of action

Supports training

Is a reference for future changes

Some forms of project documentation a project manager should be prepared to handle include:

Meeting agendas and minutes (see below)

Communication planning and tracking

Workflow and process redesign

Requirements specification

Selection evaluation

Issues log

Plans and progress

Budgets and invoices

Change control

Patient consent forms

Satisfaction surveys

Version control is often a challenge in managing project documentation. Be sure that every document created for the project reflects:

Name of the organization

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Name of the person who created the document

Name of the person who approved the document (such as policies, agreements, contracts, changes to systems)

Date of creation

Subsequent dates of revision

Tips on Managing MeetingsCommittee meetings are essential for planning, making decisions about, and optimizing use of EHR and HIE, but they are also notorious for taking up valuable time. Here are some ways to work more effectively in meetings:

□ Hold a meeting about meetings to start off on the right track. Review the following tips and establish ground rules. Think about how to facilitate meetings, draw people out, communicate effectively, etc. Many organizations have dysfunctional meetings because they have never taken the time to study their processes and correct them.

Meetings should be held to make decisions, take action, or obtain information that cannot be learned independently. Circulate reports a few days before a meeting and set the expectation that they will be read by the time of the meeting.

Assign groups specific tasks and the authority to accomplish those tasks outside of the steering committee. These groups—the domain teams—may choose to work by a nominal group process for structured problem solving or informally over lunch. Encourage them not to hold formal meetings; suggest they hold stand-up meetings or have hallway conversations instead.

Always adopt an agenda and stick to it for all formal meetings. The agenda should be action oriented with specific, assigned responsibilities for each member. Keep track of all items on the agenda and ensure each one gets accomplished, even if it is deferred.

Meetings must start on time, even if only one person is present. Except in a true emergency, arriving late to a meeting shows disrespect for fellow members and upsets everyone’s schedule. Meetings must also end on time.

Identify follow-up activities and assign lead individuals and deadlines. The chair of the meeting and/or project manager should follow up with these individuals immediately after assignment to ensure they understand the task and have the tools to perform it. Follow-up should continue until immediately prior to the assignment deadline to ensure the task is completed.

Use a “sergeant-at-arms” if necessary to put distracting conversations into a parking lot and to halt discussion if someone is being obstructive, unprepared, or off course. Rotate the sergeant-at-arms for each meeting so no one person is viewed as the “bad cop.”

Have fun and celebrate accomplishments. Implementing EHR and HIE is hard work and may be among the most challenging and largest investments the organization will make. Organizations that recognize the need to “work hard and play hard” and to negotiate compromises are generally the most balanced, effective, and efficient.

Sample Agenda and MinutesAgendas and minutes are important elements to ensure that meetings are run smoothly. A sample agenda using a standard form to capture key elements for creating the minutes, an example of the resulting minutes, and a blank template follow.

Sample HIT Steering Committee Agenda

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Date: Oct. 14 Time: 1:00 – 2:30 PM Location: Conf Rm B

Invitees: Ms. Adams (leader), Dr. Brown, Ms. Jones, Mr. Madison, Ms. Smith, Mr. Underwood

Time Action Outcome

1:00 PM Determine if anyone has any questions or corrections to minutes or progress report (sent Oct. 10)

Narrow field of vendors from 10 researched by the EHR Domain Team to 5 to send RFP

1:10 PM Ms. Adams review key differentiating factors (attached) approved at last meeting

1:20 PM Ms. Smith present matrix comparing vendors on key differentiating factors (attached)

1:30 PM Discussion

2:15 PM Vote

2:20 PM Assign RFP Domain Team to assist Ms. Smith in finalizing RFP

Review accomplishments

Identify improvements to meeting process

2:25 PM Identify topics for next meeting

2:30 PM Adjourn

Sample HIT Steering Committee MinutesDate: Oct. 14, 2009 Time: 1:00 – 2:30 PM Location: Conf Rm B

Present: Ms. Adams (leader), Ms. Jones, Ms. Smith, Mr. Underwood

Absent: Mr. Madison (excused)

Time Action Outcome

1:00 PM Determine if anyone has any questions or corrections to minutes or progress report (Oct. 10)

None

Narrow field of vendors from 10 researched by the EHR Domain Team to 5 to send RFP

Clarification sought and made to key differentiator on vendor support.

- Vendor J met all key differentiating factors; however, it is being acquired by Vendor X. This acquisition will be in

1:10 PM Ms. Adams review key differentiating factors (attached) approved at last meeting

1:20 PM Ms. Smith present matrix comparing vendors on key differentiating factors (attached)

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Vendor J’s favor.- Vendor H is a local vendor with 5 clients,

but no national presence. Vendor H meets all key differentiating factors except for the ability to perform real time alert messaging. Vendor H was rejected.

- Vendors B, C, E, F, and I do not meet several key differentiators and were rejected.

- Only vendors A, D, G, and J meet all key differentiating factors at this point in the analysis and will be sent RFP.

1:30 PM Discussion

2:15 PM Vote

2:20 PM Assign RFP Domain Team to assist Ms. Smith in finalizing RFP

Team comprised of Ms. Jones, Ms. Adams, Mr. Madison

Special thank you to Ms. Jones for polling other LPH departments about their ability to use a provider portal, to Ms. Smith for facilitating the discussion to reach a list of candidate vendors, and to Mr. Underwood for researching vendor J. Members were reminded to follow the Code of Conduct for Vendor Selection and to direct all vendor contacts to Ms. Smith.

2:25 PM The next meeting will be Oct. 21 to- Approve the RFP- Develop the RFP response evaluation form

2:30 PM Adjourn

Agenda/Minutes TemplateHIT Steering Committee Agenda/Minutes

Date: Time: Location:

Invitees (list for agenda):

Present (list for minutes):

Absent (list for minutes):

Time Action Outcome

Review accomplishments

Identify improvements to meeting process

Identify topics for next meeting

AdjournCopyright © 2014, Margret\A Consulting, LLC. Used with permission of author.

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Copyright © 2014 Stratis Health. Updated 01-01-14

Section 2 Plan—Project Management - 1