implementation of an ehr: focus on vista claudine d. beron, pmp january 7, 2006 claudine d. beron,...

Implementation of an EHR: Focus on VistA

Claudine D. Beron, PMP January 7, 2006

Claudine D. Beron, PMPJune 26, 2007

/21/23 VistA Software Alliance Presentation

Agenda

• Need for an EHR• Implementation Lessons Learned• VistA Implementations• Project Management & PMI Methodology

• Project Life Cycle• Project Process Areas

• Project Management for VistA• Use Case on VistA


• 10% to 15% of the nation's doctors outside of the military and the Department of Veterans Affairs are using EHRs

• 33% of surveyed hospitals reported having PACS installed*

• 10% of surveyed hospitals have CPOE systems installed*

• 62% of US hospitals state that IT investment was a top priority

• * 2004 HIMSS Analytics database of 4000 hospitals surveyed and Commonwealth Fund International Health Policy Survey (2003).

Need for an EHR


Reasons to Implement an EHR

• Enhance the quality of patient care • Decrease and avoid medical errors - could save at least 44,000 and

as many as 98,000 lives in the U.S. per year1• Increase the profitability of the practice or facility - could yield a net

value of $77.8 billion per year once fully implemented throughout the U.S.2

• Reduce costs • Increase revenue • Improve the proper coding of patient encounters - defensible coding

• Provide backup documentation for:

– Insurance company claims inquiries – Malpractice allegations – Comply with HIPAA – Facilitate decision support, clinical trials, and medical research

EHR Implementation Lessons Learned


Key to Implementation of an EHR

EHR implementation entails more than installing electronic tools-it's an opportunity to transform the entire organization. To use technology to improve patient safety and care efficiency, examine the assumptions that underlie quality care and consider which elements to maintain or improve.


• Both vendors and providers have commented that a large number of implementation failures exist in the industry typically as a result of poor vendor support and training. These failures impact the adoption rate of IT in the healthcare arena including EHR adoption. – reluctance of some of the doctors in a practice to use the HER– insufficient support and training – Perceived no return on investment or improvements in quality of life– unrealistic expectations

Lessons Learned


Sample Implementation Road Map


VISTA INFORMATION SYSTEM

USERSECURITY

MAILMAN

DEVICE MANAGER

MENU MANAGER

RPCBROKER

INTEGRATED DATABASE

PATIENTS

WARDS

DRUGS

PERSONS

INVENTORYPRESCRIPTIONS

IMAGES

LAB RESULTS

VISTA SOFTWARE PACKAGES

SCHED-ULING

INPATIENTPHARMACY

LABORATORY

SURGERY

MEDICINE

SOCIAL WORK

DENTAL

ENGINEERING

INTEGRATED FUNDS CONTROLACCOUNTING &PROCUREMENT

ADMISSIONDISCHARGETRANSFER

DIETETICS

MENTALHEALTH

HEALTHSUMMARY

NURSING

LIBRARY

PATIENTFUNDS

MEDICALRECORDSTRACKING

ACCOUNTSRECEIVABLE

VOLUNTARYSERVICE

REHABMEDICINE

RADIOLOGY

ONCOLOGY

COMPUTERIZEDPATIENT RECORDSYSTEM

(CPRS)

KERNELTASKMANAGER

VA FILEMAN

TEXTINTEGRATION

UTILITIES (TIU) OUTPATIENTPHARMACY

CLINICAL PATIENT RECORD

AUTHORIZATION SUBSCRIPTION

UTILITY (ASU)

BAR CODEMEDICATIONADMINISTRATION

WOMEN’SHEALTH

BLOOD BANK PROBLEM LIST

VistAIMAGING

CONSULTS /RESULTTRACKING

CLINICALREMINDERS

MEDICAL CARECOST RECOVERY

Sites of Care•Clinics•Hospitals•Nursing Homes•Domiciliary•Home/Workplace

VistA

VistA Implementation

04/21/23 VistA Software Alliance Presentation

Specific Examples include : National Deployments:1. Department of Veterans Affairs, (VistA)1007 sites-CONUS/OCONUS2. Department of Defense, (AHLTA) 105 sites CONUS/OCONUS 3. Indian Health Services, (RPMS) 600 sites

Single or Multi-site Implementations:1. California Department of Corrections2. California, Oroville, Oroville Hospital 3. District of Columbia – Department of Health (Dimensions Intl.) 4. Hawaii - Clint Spencer Clinic 5. Hawaii - Physician Center at Mililani (island of Oahu, Hawaii)6. Hawaii, University of Hawaii Department of Geriatric Medicine (John A. Burns School of

Medicine)7. Oregon, Center for Women and the Family8..Oklahoma Department of Veterans Affairs -8 sites 9. Oklahoma, Midwest City, Midwest Nephrology Associates, 10. New Mexico, Albuquerque, Presbyterian Health Service, 11.Texas, Midland, Midland Memorial Hospital -9 sites 12. Washington, Tacoma -Western State Hospital 13. Washington , Tacoma, Child Study & Treatment Center 14. Washington, Spokane, Eastern State Hospital 15. West Virginia, Bureau for Behavior Health and Health Facilities of West Virginia's

Department of Health and Human Resources (7 sites) 16.West Virginia, Community Health Network of West Virginia (Network)

VistA Implementations in the US


Specific Examples include : 1. American Samoa - Lyndon Baines Johnson Tropical Medical Center (LBJ TMC)

2. Colombia, Bogata, Government hospitals

3. Czech Republic , XORS Inc.

4. Egypt, Cairo, National Cancer Institute

5. Finland, Helsinski, Helsinki University Hospital

6. Finland, University Hospital of Kuopio,

7. Germany, University of Wurzburg, Germany

8. Germany, Berlin, German Heart Institute

9. Kenya, Nairobi, World Health Organization's Collaborating Center on AIDS and Sexually Transmitted Diseases, University of Nairobi School of Medicine

10. Mexico - Instituto Mexicano del Seguro Social (12 hospitals)

11. Uganda, Kampala, Nakasero Blood Bank

12. Nigeria, Obafemi Awolowo University Teaching Hospitals

13. Pakistan, SKM Cancer Hospital and Research Centre

VistA Implementations Worldwide

Project Management &PMI Methodology


PMI Methodology

Project Management is not a cookie cutter skill set. Many project managers come from technical, clinical or other areas of expertise and are asked to manage projects for their organization without adequate training or skill development. The Project Management Institute (PMI) has developed a methodology and tools that are widely accepted throughout the world to help manage projects are all levels (500K to 100M) and industries (Construction to Health care). As every Project/Program Managers is unique, every project is, especially in health care.

•Tell me about the projects you’ve managed projects previously?


Plan Method/Approach

Schedule

Dependences

Resources

Cost

Project Charter

Execute Deliver

Manage

Control Cost

Schedule

Resources

Project Management is accomplished through the use of the core areas including: initiating, planning, executing, controlling, and closing and represents over 44 processes. Each is interdependent to the other and iterative in the project life cycle. The PM process covers all phases within the life cycle of any project. A standard project will typically have the following phases:

It is important to note that many of the processes within project management are iterative in nature. This is in part due to the existence of and the necessity for progressive elaboration in a project throughout the project life cycle

Initiate Sponsor

Requirements

Funding

SOW

Contract

Close Cost

Schedule

Resources

PMI Methodology


Initiate Phase

Initiate Phase• 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.

Scope

Develop Charter

Scope

Develop PreliminaryScope Statement

InitiatingProcessGroup

Initiating Process Group Processes

A Guide to the Project Management Body of Knowledge – 3rd edition, PMI organization.


Plan Phase

Plan Phase• 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:– Identifies specific work to be performed and the goals that define the project– Provides documented estimates regarding schedule, resources and cost for

planning, tracking, and controlling the project– Obtains organizational commitments that are planned, documented, and agreed

upon– Continues the development and documentation of project alternatives,

assumptions, and constraints– Establishes a baseline of the plan from which the project will be managed.


Plan Phase

Planning Process Group Activities

DevelopCommunications

Plan

Develop ScopeManagement Plan

Develop QualityManagement Plan

Develop RiskManagement Plan

DevelopHuman ResourceManagement Plan

DevelopProcurement

Management Plan

Develop CostManagement Plan

DevelopSchedule

Management Plan

Develop IntegratedChange Control

Process & Management Plan

Develop ProjectOrganization

Obtain ProjectTeam Staffing

Define ScopeStatement

(Project Objectives,Product,

Deliverables)

Develop WBS(Scope

Definition)

Define WorkActivities

SequenceWork

ActivitiesScheduleActivities

Identify WorkActivity

Resources

Estimate WorkActivity

Durations

Identify andAnalyze Risk

Events

Develop RiskPlans

Estimate Costof Activities(Resource &

Risk)

ProjectMgmtPlan

Management Plans(How the project will be managed during it’s executing, monitoring and controlling process groups)

EstablishActivity Based

Budget

Planning Process Group Activities



Execute Phase

Execute Phase • 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.

• The Executing is where 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:– Conduct, coordinate and manage the ongoing work activities– Perform quality assurance activities continuously to ensure project objectives are being met or

achieved– Monitor identified risks for triggering events and implement containment or contingency

strategies as necessary– Distribute information to project stakeholders– 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.


Execute Phase

Integration

Project ManagementPlan Execution

Quality

Communications

InformationDistribution

Communications

TeamDevelopment

Procurement

Source Selection

Plan Contracting

Procurement

ContractAdministration

PlanningProcessGroup

ControllingProcessGroup

Procurement

Executing Process Group Processes



Execute

• During an EHR implementation, staff from nearly every department is affected. The project manager’s key role is to coordinate the different program units and develop the infrastructure required to plan for, carry out and monitor the EHR implementation. The project plan is vital as it details the timing and sequence of the implementation, as well as identify areas in which the workflow may require redesign. All project management activities are documented using standard templates and updated regularly.


Execute – Change Management

• The implementation of an EHR system creates significant organizational change. It is an intense process, because providers, nurses and staff are being asked to do their work in a new way. Often change engenders reactions, such as fear, resistance, even anger, so planned change management is essential to the success of the implementation project. Experience has shown that the most successful implementations demonstrate three key change management characteristics: top-down support for change; well-managed teams that share the implementation tasks; and support for new system end users by providing them additional time to learn the system while not being swamped with patient appointments.


Control Phase

Control Phase • 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:

– Scope Change Control – Risk Monitoring and control – Cost control – Performance Reporting


Control Phase

Scope

ScopeVerification

Scope

Scope ChangeControl

Procurement

Quality Control

Time

Schedule Control

Procurement

Risk Monitoring& Control

Communications

PerformanceReporting

Integration

Integrated ChangeControl

PlanningProcessGroup

CloseoutProcessGroup

ExecutionProcessGroup

Cost

Cost Control

Monitoring and Controlling Process Group Processes



Close Phase

Close Phase • 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.

Procurement

Contract Closure

Communications

Close Project

ControllingProcessGroup

Closing Process Group Processes


Dynamic of a Project

Change

Management

Stakeholder Management

Config

urat

ion

Man

agem

ent

Qua

lity

Ass

ura

nce

Risk/Issue Management

Resource Management

Knowledge

Management

Comm

unication

Managem

ent

Sub

cont

ract

or

Man

agem

ent

Manage a Project

Stages

Initiate Plan Execute Control Close

Organization Budget Limits

Organization Commitment

Internal Politics

Obtaining the Right Skill Sets

Capturing Information

External Politics

Budget Cycle

Expectation Setting

Solution Functionality


Key Considerations

There are three key considerations that are most important to build a successful project:

•Deliver to contract requirements –setting expectations with the customer and ensuring that they understand what they will

receive. A successful project is not one that delivers to customer requirements.

•Manage within Schedule – building a detailed enough work plan is essential to managing to milestones and schedule.

•Manage within Budget – keeping close control on hours by the team is crucial as well as other ODCs that must be paid for to complete contract requirements.

VistA Implementation Methodology


Plan Method/Approach

Schedule

Dependences

Resources

Cost

Project Charter

Execute Deliver

Manage

Control Cost

Schedule

Resources

Project Management is accomplished through the use of the core areas including: initiating, planning, executing, controlling, and closing and represents over 44 processes. Each is interdependent to the other and iterative in the project life cycle. The PM process covers all phases within the life cycle of any project. A standard project will typically have the following phases:

It is important to note that many of the processes within project management are iterative in nature. This is in part due to the existence of and the necessity for progressive elaboration in a project throughout the project life cycle

PMI Project Life Cycle

Initiate Sponsor

Requirements

Funding

SOW

Contract

Close Cost

Schedule

Resources


Project Management for VistA is accomplished through the use of the core areas including: initiating, planning, executing, controlling, and closing and represents over 44 processes from PMI.

VistA Project Life Cycle

Accept Identify Owners

Identify Stakeholders

Future Budgeting

Complexity

Assess Environment

Needs

Standard Operating Procedures

Benefits

Resources Strain

Budget

Deploy Hardware

Software

Configure to Environment

Educate Compare EHRs

Build Business Case

Develop ROI

Understand Functionality

Train Ongoing

maintenance

Clinical Staff

Support Ongoing

maintenance

Updates/Patches

Additional modules

Initiate Plan Execute/Control Close


Foundation Fileman

Kernel

Mailman

Core Lab

Radiology

Pharmacy

Standard CPRS

Dietetics

Social Work

Extended Imaging

BCMA

The interdependent architecture of VistA dictates a sequential implementation approach. Each project plan must first begin with the implementation of the PIMS to bring registration, bed control and scheduling on-line.

Other departments such as laboratory, radiology and pharmacy may then be automated. Through this process a fully functioning CPRS with physician order entry may be achieved.

PMI must be founded upon these requirements to maximize staffing efficiency. The systematic automation of hospital processes will also act to reduce the disruptive effects of large scale efforts.

VISTA Implementation Methodology


1. Executive Sponsorship2. Involvement of key stake holders right from the beginning3. Focus on Change Management not just technology4. Well defined project plan with milestones and critical path 5. Accountability and process to make timely decisions6. Risk mitigation – can’t eliminate risks; have to manage it7. Defining the vendor performance and monitoring it8. Assignment of requisite resources 9. Managing the expectation setting10. Communication, communication, communication

It is a marathon not a sprint

Implementation Key Criteria

Project Managementfor VistA


Project Management for VistA is accomplished through the use of the core areas including: initiating, planning, executing, controlling, and closing and represents over 44 processes from PMI.

Accept Identify Owners

Identify Stakeholders

Future Budgeting

Complexity

Assess Environment

Needs

Standard Operating Procedures

Benefits

Resources Strain

Budget

Deploy Hardware

Software

Configure to Environment

Educate Compare EHRs

Build Business Case

Develop ROI

Understand Functionality

Train Ongoing

maintenance

Clinical Staff

Support Ongoing

maintenance

Updates/Patches

Additional modules

Initiate Plan Execute/Control Close

VistA Methodology


VistA Case Study

• Holly Cross is a New York-based system that provides more than 1 million acute care visits each year through two major hospitals with over 500 inpatient beds and 38,210 annual discharges, and nine clinics. In the spring of 2006, senior administrators proposed implementation of electronic health records (EHR) to its medical staff.

• The executive team viewed EHR usage as integral to the organization's strategic business plan, citing the need to support an infrastructure of care reorganization, refined quality measures and reporting processes, and evidence-based practice for management of chronic disease. Stakeholders would measure the implementation's success by how well EHR technology improved patient safety and care delivery, such as retrieval of patient information and clinical documentation throughout the health network. The system has planned a budget of $5 million per year for the next 3 years to implement an EHR and the first implementation must be completed in the next 6 months. Discuss what needs to be discussed and agreed upon for this to happen.


VISTA Project Management

Initiate• Educate Your Organization on VistA/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/LongTerm/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)



Plan• On Site Assessment of the Environment's)

• Detail questions/interviews for each clinical area to implemented VistA 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



Execute• Build Test/Development System

• Include staff responsible for ongoing maintenance for training• Document System (Build Guide, Configuration Guide)• Test System prior to implementing VistA

• Load VistA 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



Control• Scope Change 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.



Close– 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– Conducting a project review with all stakeholders

• Documenting lessons learned• Completing, collecting and archiving project records

– Celebrate!


Process Benefits Risks if not completed Deliverable

Scope & Plan

Clearly define the roadmap for the project Milestone achievements meet financial

parameters and expectations The plan becomes the basis for ongoing

progress assessment Roles and responsibilities are clearly

delineated Accountability for Executive Team in driving

project success and achieving the organizational objectives and vision

Project failure with lost revenue and margin

Confusion, frustration and lack of buy-in for all staff and project team

Inefficient allocation of project resources

• Project Plan• Software Communication

Plan• Risk Assessment• Resource Plan• Testing Plan• Technical Plan

Design

Stakeholder engagement Early awareness of gaps between desired

and actual functionality

Increased end user resistance Potential adverse financial

impact of redesign Inability for end users to

perform job Greater risk of medical error and

sentinel event

• Solutions Design Session • Signoff• Reporting Specifications• Risk Management • Assessments

Configure & Prototype

Functioning system Milestones and benefits are not realized

• Proof Of Concept Demo • Functioning Application

Develop & Test

Determination if code functions as designed per client requirements

Increased confidence in the system Production readiness which drives the

transition and preparation activities

Delayed conversion with much higher costs

Potential non-functioning, error prone system

If duplicate effort and workarounds are required, staff overtime, additional staffing and/or agency expense are incurred

• Test Plan• Code Issue

Identification/Resolution• Performance Issue

Identification/Resolution• Completed System

Interfaces• Conversion Readiness

Assessment

Implement & Support

Achievement of strategic vision Greater medical and clinical staff system

acceptance

Loss of capital investment and operational efficiency

Decreased staff retention Loss of medical and clinical staff

acceptance

• Functioning CPRS system For End Users

• Post-Conversion Assessment Plan

VISTA Implementation Matrix


Solutions Benefits Risks if not completed Deliverable

Change Assessment

A quick but comprehensive assessment of the organization to determine its ability to absorb VistA based on financials, operational / clinical performance and project risks

All staff will understand how their jobs will change by new processes & IT

Solutions may not be prioritized to focus on immediate gains.

Project champions will not be identified, Efforts will not be aligned with goals Organizational productivity metrics will

not be established in strategic planning Key SOPs will not be re-deigned

Organizational Change Plan

Infrastructure Assessment

SOP Analysis Training Analysis Risk Assessment

Stakeholder Ownership

Identify risks, barriers, and enablers of change

Leadership alignment with localized sponsorship and change management network

Ability to manage resistance/stakeholder buy-in

Heightened resistance with lack of adoption for new processes, systems, roles/responsibilities

Poor decision-making, rumor mills, buy-in less likely, lack of commitment from stakeholders, and nonaligned leadership

Increased employee turnover

Stakeholder Analysis Project Leadership

And Champion Assessment

Communication Plan Delivery

All impacted audiences are identified, informed, and engaged and connected with project team

Increased buy-in from bottom-up

Chaos during transition. Impacted audiences unaware of changes and their respective roles

Communication Plan

Organization Design

New job/role descriptions Effective and efficient utilization of

resources Organization structure aligned with

strategic planning and job design

Lack of cross-functional coordination and misuse of resources, duplication of effort and unclear value chain

Ambiguity related to roles & job tasks

Organization Chart Job Descriptions

End-User Training Staff and clinicians have skills to perform their roles & responsibilities

Define necessary materials for a successful training

End-users gain confidence in their roles, and with new system

Lost productivity, confusion, unsuccessful project with increased level of resistance

End-users unable to perform their jobs

Learning Assessments And Learning Plans

Training Curriculum

Team Integration Significant collaboration during intense and chaotic project life-cycle

All changes are well understood by myriad of stakeholders, project teams and leaders

Lack of coordination and duplication of effort

Poor team and organizational performance with low productivity / morale

Team Development Plans



Solutions Benefits Risks if not completed Deliverable

Technology Roadmap

Technology solution consistent with care transformation goals

Long term technology strategy mapped Address high risk of technology to project

success

Insufficient funds allocated to support the system

Technology not sufficient to support care transformation

Inability to plan for project adequately.

Technology Workshop Integrated Project

Plan Client Technology

Roadmap

Access Strategy Align the the accessibility of solutions with the client’s strategic plan

Create remote access strategy

Provider efficiency affected by inadequate device strategy

Impedes buy in of system by physicians if can't access information remotely

Network Assessment Design Documents Hardware Medium

Assessment

Security Risk Assessment

Understand authentication solutions that match business and industry requirements

Violation of patient privacy (HIPAA) Difficulty of adding security if not built

into solution May risk noncompliance with JCAHO

standards

Security Policy & Risk Assessments

Performance/Capacity

Management

Performance methodology in place System performance is baselined Load is modeled Removes client need to try to create load

manually

Performance issues appear after go-live

Poor understanding of VistA impact upon organizational effectiveness

Reactive performance management driven by end-user impact

Baseline Performance Results

Desktop Assessment

Operational Readiness

Proactive detection of events that could impact production

Trend analysis that will provide capacity planning for managed components.

Network (near future) event and trend / capacity management

Central control and distribution of managed components

Decreased client satisfaction due to undetected failure of manageable components

Unable to proactively determine capacity or trend of managed components

Reactive not proactive model of support. No central control of client issues

Trend, event and escalation of events



VistA Reading

1. Kalchugina, Townsend, “Medical Records in the Greater Los Angeles State Veterans Home: A Unique Opportunity to Improve Quality of Care http://repositories.cdlib.org/lewis/sr/student_report_02/

1. West; O’Mahony, “Contrasting Community Building in Sponsored and Community Founded Open Source Projects,” Proceedings of the 38th Annual Hawai‘I, International Conference on System Sciences, Waikoloa, Hawaii, January 3-6, 2005. http://opensource.mit.edu/papers/westomahony.pdf

2. Goldstein, Ponkshe, Maduro, “Profile of Increasing Use of OSS in the Federal Government and Healthcare” http://www.medicalalliances.com/downloads/files/Open_Source_Software-Government_and_Healthcare_White_Paper-Medical_Alliances_2.doc

3. The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care , The American Journal of Managed Care, November, 2004. http://www1.va.gov/cprsdemo/docs/AJMCnovPrt2Perlin828to836.pdf

4. Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample , Annals of Internal Medicine, December, 2004. http://www1.va.gov/cprsdemo/docs/Internal_Medicine_Article_on_VistA.pdf

5. The Best Care Anywhere , Washington Monthly, January/February, 2005. http://www1.va.gov/cprsdemo/docs/Article_Washington_Monthly_Jan_Feb_2005.doc

6. Brown, Lincoln, Groen, Kolodner, “VistA – US Department of Veterans Affairs National Scale HIS,” International Journal of Medical Informatics. February 2003 http://www1.va.gov/cprsdemo/docs/VistA_Int_Jrnl_Article.pdf

7. Munnecke, Tom, “Personal Health: From Systems to Space,” July 19, 2002

8. Hanson, Susan P. "HIM Role in Bringing e-HIM to Small Practices." Journal of AHIMA 76, no.4 (April 2005): 54-55,65. http://library.ahima.org/xpedio/groups/public/documents/ahima/pub_bok1_026428.html


EHR Reading

1. Terry, Ken, “IT Implementation: Why EHRs falter ,” April 7, 2006 http://www.memag.com/memag/article/articleDetail.jsp?id=316528&&pageID=1

2. IT Executives Offer Advice for Adopting Electronic Records MAY 21, 2007 http://emradvice.wordpress.com/tag/emr-failure/

3. Planning, Early Support Keys to EMR Success, Execs Say, May 21, 2007 http://emradvice.wordpress.com/2007/05/21/planning-early-support-keys-to-emr-success-execs-say/

4. Brief Report of the AAFP’s EHR Pilot Project: Key Learnings from Six Small Family Practices American Academy of Family Physicians Center for Health information Technology March 8, 2005 http://www.centerforhit.org/PreBuilt/chit_pilotresults.pdf

5. Kenneth G. Adler, How to Successfully Navigate Your EHR Implementation , February 2007 http://www.aafp.org/fpm/20070200/33howt.html

6. Laurie Craven, RN, So, you’re the project manager! http://www.doqit-tx.org/newsletter/DOQ-IT%2002_07.htm


PM Reading

1. A Guide to the Project Management Body of Knowledge,(2000 edition)

2. Effective Project Management, Chapter 6. Wysocki / Beck Jr. / Crane.

3. The New Project Management, Chapters 8, 12-13, Frame, J. Davidson, 1994

4. Earned Value Project Management, Second Edition, Chapter 5. Flemming and Koppleman

5. Project Management: A Managerial Approach, pp. 43-44. Meredith and Mantel

6. PMBOK (2000) Q&A, PMI, Scope Section

7. Ten Steps http://www.tenstep.com/

8. AllPM http://www.allpm.com/

9. C. William Ibbs, Young H. Kwak, “Calculating Project Management’s Return on Investment” http://www.ce.berkeley.edu/pmroi/calculating-PMROI.pdf

10. PMBoulevard http://www.pmboulevard.com/


VistA Links

VistA-CPRS Demo - http://www1.va.gov/CPRSdemo/

CMS - VistA Office EHR – http://www.cms.hhs.gov/quality/pfqi.asp#Vista-Office%20EHR

Indian Health - RPMS - http://www.ihs.gov/Cio/RPMS/index.cfm

DoD - CHCS http://www.tricare.osd.mil/peo/citpo/projects.htm

Pacific Hui - http://www.pacifichui.org/

WorldVistA - http://www.worldvista.org

Hardharts.org - http://www.hardhats.org/

Vista Software Alliance- http://www.vistasoftware.org


Contacts

Claudine Beron, PMPAccenture

703-947-3610703-599-1203 cell

[email protected]

implementation of an ehr: focus on vista claudine d. beron, pmp january 7, 2006 claudine d. beron,...

Documents

ehrehr implementation

surveyed hospitals

quality care

ehr adoption

patient safety

decision support

herinsufficient support

care efficiency