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Final Study Guide – HSER 4380 Exam 3

Chapter 11: HIT Project Portfolio Management

1. Discuss some of the primary reasons an HIT implementation project might fail in a
healthcare organization.

 Following “silo” project management which includes initiating, planning, and

executing the projects.
 Executing the projects without considering or estimating their impact on other
systems can cause the failure as the projects be planned or executed parallel.
 As healthcare applications are interdependencies as they affect each other. So,
failure may cause, when applications are not designed or implemented
considering each functionality.

2. What are the main differences between HIT project management, HIT program
management, and HIT portfolio management?

Project Management Program Management Portfolio Management

1. It involves management It Involves managing only It involves management

of multiply interrelated single whole project. of collections or
projects. programs.

2. It helps in providing It helps in managing It helps in providing HIT

automated support in
providing qualitative and
quantitative output.
interrelationships among
the projects and the
applications used in the
projects.
governance decisions of
the projects used and in
achieving organization’s
overall goals and
objectives.

3. What are the five processes of project management?

Five Key Processes of Project Management:

Project management connects all project tasks or activities of the project from the
starting till end and continues for the time duration when all the required tasks and the
steps come to the end and all processing is closed.

There are five key processes that help in the project management for making it
professional and successful. They are:
1. Project Initiation
2. Project Planning
3. Project Execution
4. Control and Validation
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5. Closure and Evaluation

Project Initiation:
 In this process companies try to convince the client that they will complete the
project on time and provide great quality.
 After obtaining it from the client, service providers collect all the requirements of
the project and analyze it for the implementation.
 Mutual settlement between the service providers and clients take place regarding
the alteration of the requirements.
Project Planning:
 The critical step of project management. The project utilities such as scope, budget
and timelines are decided.
 Project guidelines and deadlines for every task are prepared. Depending on the
timeline project is allocated to the resources.
 This process is crucial as decision making takes place in this process. If this step gets
wrong, rest of the project gets affected.
Project Execution:
 Project design takes place in this phase. After it is done project is executed to
achieve the objectives. This process is carried out in teams. Every member of a
team is assigned some task and there is deadline for every task.
 Project’s progress report is prepared and reported to the senior manager of the
project. Client also tracks the progress of the project to see if it is in right
direction.
 Project is divided into several deliverables and must be met within the timelines.
Control and Validation:
 Project activities should be monitored and validated continuously. This can be
done protocols such as project plan, quality assurance test plan and
communication plan for the project.
 Each task should be validated throughout the project. Every task has different
criteria and method of validation. This method should be applied for the success
of the project.
 Separate team called ‘quality assurance team’ will assist the project team for
validation and verification functions.
Closure and Evaluation:
 When all the requirements of the project are achieved, it is handed over to the
client. If the deliverables are met it is accepted by the client and paid.
 After the closure of the project, evaluation of the whole process takes place.
Mistakes made by the team are evaluated and steps are taken to avoid them in
future.
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4. What requirements should be considered when selecting project management tools for
an organization?
Requirements for selecting project management tools
There should be a wide variety of tools to execute project. These tools can be specific
designed tools for special type of task or common tools for general tasks. The use of tools
makes work easy for project managers. These should be common to all projects to bring
standardization in of project management processes.

Project Plan – It is the critical step of project management. The project utilities such as
scope, budget and timelines are decided during this phase and using this project plan
document.
 Project guidelines and deadlines for every task are prepared. Depending on the
timeline project is allocated to the resources.
 This process is crucial as decision making takes place in this process. If this step
goes wrong, rest of the projects gets affected.
Milestone Checklist – This tools is used by project managers to see if progress of project is
on track or not. Excel sheet can be used to make a checklist and it should be updated
whenever required.
Gantt Chart – Gantt Chart depicts is used for representing and denoting the schedule and
timeline of the project.
 It also expresses the interdependency of the activities of the project with one
another. For any type of project construction or software development, these can
be used as a tool.
 It becomes complex as many tasks are involved. If the project is small Gantt charts
can be prepared in MS-Excel and if the project is complex software tool project can
be used.
Project Management Software: Project can be used by project managers to keep track or
project progress.
 It is an effective tool in a way that it is alone sufficient to carry out all types of
evaluation required by the project.
 It can satisfy graphical needs to project managers. It can integrate the project
parts after completion.

5. Why are project metrics and portfolio dashboards important to HIT governance?
Project Metrics and Portfolio Dashboards:
 Portfolio dashboards are created from project/portfolio management
applications or from other enterprise dashboard tools.
 Portfolio dashboards are used to know the project progress and the budgets of
each category in the project.
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 It is important in HIT governance as it helps in providing strategic views and

provides flexible data representations of the portfolio of the entire project.

6. List and describe the major roles and functions of the PMO.

PMO stands for Program Management Office:

 Which is the collection of department which maintains the project management
standards. It is generally involved in delivering the leading healthcare services
and other IM/IT portfolio management services. There should be a head of PMO
who will run the PMO office.
There are certain roles and functions of PMO:
1. In PMO there is a Portfolio Analyst, who will perform the role of manager who
will analyze portfolio development.
2. A Project Specialist which is a part of PMO will see if the standards of project
management are met or not.
3. PMO also performs the role of analyzing the benefits which will make them
realize benefits in any project.
4. Commercial Role: It ensures that the organization carries out all commercial
practices and decisions are taken that offer the organization value for money. It
also helps in maintaining good relationships with clients and vendors.
5. All the project information is acquired by PMO and it also performs the financial
role by establishing a financial control on the project management.
6. Resource Management Role: It ensures resources are as per the requirements
and employees possess required skills.
7. Risk Role: It ensures the all risk factors are identified and essential actions are
taken to deal with these risks.
8. Reporting Role: It checks that proper reporting is done hand handed over to the
senior managers and clients.

7. Which two project management knowledge areas described in Exhibit 11.5 do you
consider to be the most important? Why?
The most Important Two Project Management knowledge areas are:
1. Project Scope Management is important as it helps in collecting the project
requirements, also to know the exact scope or the required output of the project
and it helps in creating work breakdown structure, as work breakdown structure
will give the list of tasks to be done to manage the project.
2. Project Quality Management is important as quality is very important for the
project or the product. When the planning is done with utmost quality then only
the required project output can be achieved.
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8. What actions/changes are necessary within an organization to reach the synchronized

stage of maturity of Jeffrey and Leliveld’s IT Portfolio Management Maturity Model?

Organization to reach synchronized state of maturity:

 Regular communications should be maintained with the stake holders.
 Within the portfolio, the authoritative management should be provided and
oversight should be provided for all projects.
 Staff support should be provided in the organization.
 Metrics and dashboards must be created which help to facilitate transparency.

9. Even with the development of a PMO, will there be instances in which an HIT venture
fails? Explain your rationale.

Hit venture failure:

 Even though after establishing and developing an HIT PMO, the HIT venture can
be a failure as establishing PMO is not easy.
 Establishing PMO cannot be a quick fix and requires much effort.
 For establishment and to generate significant benefits for organization, it
requires likely at least two to four years
 There can be a failure as it must that PMO should work hand in hand with an
organization’s HIT governance.

Chapter 12: Knowledge-Enabled Organization

1. What is the impact knowledge on quality of care?

 Knowledge always plays a key role in any field or situation. Lack of knowledge
may cause serious errors which can lead to very serious consequences.
 Physicians may remain unaware of new cures and technologies in the field of
health care in case of no knowledge update. So, knowledge has ability to play
important role in improving decision making and quality of care and service.
 With appropriate knowledge, a patient could easily be treated with lesser or no
error. The recovery period of patient would reduce.
 It would be easier to manage the type of care different patient require. More
over patients can be applied on newer curing techniques which may be efficient.
Thus, knowledge is improving the quality of care.

2. What, if any, are the major differences between knowledge and information?

 Knowledge is something which gives some information to us. In other words, it

is data or information stored by us whether in brain or database.
 It can also be said as processes information that can be brought directly into
action. It consists of facts, perspective, judgments, exceptions, and
methodologies.
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 On the other hand, information is raw form of data which helps in enhancement
of knowledge. The information is captured, processes, and stored to be called as
knowledge.
 It consists of facts which are organized to describe as situation or condition. It is
knowledge which is used to interpret of information and to understand the
situation.

3. What is sense making, and how can it be applied to healthcare organizations?

 Sense making can be defined as ability to more precisely and accurately make
sense of a given situation. In simple words, it is power to easily understand a
situation more accurately and work for its betterment.
 Sense making helps healthcare organizations in reducing errors. This allows
organizations to understand the situation of error, identify what and where
things went wrong, thus allowing them to correct their error and improve
problem solving.
 The principles of sense making also helps in improving decision making. It allows
organization to take decision in limited time and with limited resources.

4. Define knowledge management

 Knowledge management can be defined as process of creation of intellectual

resource or modification of these resource and usage of these resources with
the aim of maximizing effectiveness of the organization.
 Knowledge management tries to capture the more information or more
knowledge from all the sources whether from within or outside the organization.
 The knowledge assets or resources are created using this vast information
gathered in the process. These assets are later used in the organization for
creation of processes that would improve the strategies or tactics that might be
used in the organization.

5. What does it mean to bake in knowledge into organizational workflows?

 Baking in knowledge into workflow means to stuff the workflow with relevant
knowledge in simple words it is addition of knowledge or in pour of knowledge
into the workflow of organizations so that it would be used in any manner
improving strategies of organization.
 The knowledge is introduced directly into the workflow instead of introducing it
in the beginning of process. So, word bake is used which in other words means
to stuff things in something already done or in process.
 This pouring of knowledge is done in different ways. Organization may use alerts
or reminders to share knowledge in the organization so that workers may use it
to improve quality of service.
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 It may be also done through evidence based order set where knowledge is
introduced based on evidence.

6. What are some of the ways that knowledge can be baked into information technology-
enabled workflows?

 There are different ways of introducing knowledge in workflow. Organizations

may use alerts when something has negative impact over the patient
 ALERTS are basically used to make health care providers attentive in cases which
are error prone. REMINDERS may be used in order remind healthcare providers
about a routine service. For example, to remind nurse to have a routine check
over patients. It may be also done EVIDENCE BASED in which click through
method is used which uses medical literature to find solution of a problem and
instantly provide it.
 ORDER SETS are the groups of medicines placed in a set as they work well in that
set rather that individually. So, healthcare providers create these sets based on
evidences and simply provide these sets to patients.
 AUTOMATED BILLING CODE is management code which is automatically
generated when patient is checking out. It generally consists of all the services
provided to the patients.

7. Why should an organization invest in enterprise data warehousing, data mining, and
data analytics capabilities?
 In the present scenario as the knowledge and information is exponentially
increasing. It has become difficult to manage this huge amount of data for an
organization.
 The problem in front of organization is that they cannot neglect any information
as it may be required at some point of time in near future. So, healthcare
organization always looks for efficient methods for managing this huge amount
of data.
 DATA WAREHOUSING is simply storage for huge amount of data without any
necessary indexing. It is mainly optimized for retrieval of relevant data at the
time when required or queried. Thus, it allows dumping of all sorts of
information into the database which is responsible for data retrieval when
needed.
 DATA MINING AND DATA ANALYTICS uses data warehouse or simply a huge data
storage base for analyzing data and study the pattern based on different
strategies. It then provides necessary information based on pattern of data
which is beneficial to improvement of quality of service. Thus, due to these
advantages it is necessary for healthcare organizations to invest in these things.

Chapter 13: HIT Value Analysis

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1. Explain why obtaining value from HIT investments is so important in today’s healthcare
environment.

Impact of knowledge on quality of care:

 Knowledge always plays a key role in any field or situation. Lack of knowledge
may cause serious errors which can lead to very serious consequences.
 Physicians may remain unaware of new cures and technologies in the field of
healthcare in case of no knowledge update. So, knowledge has ability to play
important role in improving decision making and quality of care and service.
 With appropriate knowledge, a patient could easily be treated with lesser or no
error. The recovery period of patient would reduce.
 It would be easier to manage the type of care different patient require. More
over patients can be applied on newer curing techniques which may be efficient.
Thus, knowledge is improving the quality of care.

2. How valid and reliable do you think HIT investment decisions are currently? Why?

Knowledge and Information:

 Knowledge is something which gives some information to us. In other words, it
is data or information stored by us whether in brain or database.
 It can also be said as processes information that can be brought directly into
action. It consists of facts, perspective, judgements, exceptions, and
methodologies.
 On the other hand, information is raw form of data which helps in enhancement
of knowledge. The information is captured, processes and stored to be called as
knowledge.
 It consists of facts which are organized to describe a situation or condition. It is
knowledge which is used to interpret the information and to understand the
situation.

3. What is the system nature of healthcare, and why does it affect value estimation?
Sense Making
 Sense making can be defined as ability to more precisely and accurately make
sense of a given situation. In simple words, it is power to easily understand a
situation more accurately and work for its betterment.
 Sense making helps healthcare organizations in reducing errors. This allows
organizations to understand the situation of error, identify what and where
things went wrong, thus allowing them to correct their error and improve
problem solving.
 The principles of sense making also helps in improving decision making. It allows
organization to take decision in limited time and with limited resources.
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4. What do you think will drive adoption of interoperable EHRs – cost savings or consumer
preferences? Why?

Adoption of Interoperable HER

 Interoperable electronic health records have ability to be shared by different
part of the organization. In other words, the same record can be used in all the
department of health care organizations.
 It helps in improving efficiency and consistency of information. All departments
have some information and thus cannot be misled. Also, every department gets
to know the other departments visited by the patient, so they can easily keep
track of patients on going treatment.
 At some extent drives costs saving as single element is being circulated
everywhere so cost of creating new documents is removed however this has
more focus on consumer preferences.
 It helps organizations to understand patient properly and perform treatment
accordingly. It also reduces load from patient as he doesn’t need to fill forms
every time he registers into other departments.

5. What is the evaluation problem faced by HIT investment decision makers? Why does the
matrix in Exhibit 13.2 help in understanding that problem?
HIT Investment Decision Makers:
 The evaluation problems faced by the HIT investment decision makers are to
face the challenge of deciding among competing alternatives.
 The questions which may rise are like does the investment in HIT effect like
increase, decrease, or not effect on the organizational outcomes and costs of the
organization?
 The matrix in Exhibit 13.2 effectively supports HIT decisions as it presents the
potential outcomes/cost combinations with various scenarios and it also states
straightforwardly whether the technology to be adopted or not.
 Thus, the matrix helps in understanding the evaluation problem.

6. Why do we not observe examples of all of the cells in Exhibit 13.2?

Not Observe the Example of All Cells in Exhibit 13.2:

 Description of the given tables shows simply a matrix between cost of company
and its effect on outcome.
 If the cost is increased through the investment and the increased cost has not
effect on the outcomes of the organization, then it would never be preferred to
be adopted. Hence, we do not find any example of such scenario.
 If the cost is not changed and there is improvement, it is very beneficial and so
adopting. This scenario may also work if the outcome is not changed since the
input is the same and hence this scenario is also adoptable.
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 However, if such thing are causes of the decrement in outcome, it may never be
adopted and hence no example can be found in such scenario.

7. Compare and contrast benefit-cost, cost-effectiveness, and cost utility analyses. Which
do you prefer, and why?

Benefit Cost, Cost Effectiveness, and Cost Utility Analysis

 Benefit cost analysis is done by measuring everything in terms of money. All
benefits are compared in terms of money with the cost which is already in terms
of money. The result of such analysis has reports in terms of money. For
example, benefit of $5 is coming for every $2 invested in cost.
 Cost effectiveness analysis is done when the benefits or losses can’t be
quantified, in other words the measured benefits coming out of the cost cannot
be placed in terms of value. For example, if the benefit is observed in using a
product for one year, then its life time should be extended for next year.
 Cost Utility analysis also work based on cost effectiveness scenario, however it
improves the analysis by checking the quality of work and by services analyzed
through the cost effectiveness analysis. It allows finding outcome based of the
long-term quality analysis or simply analysis of the service in long term.
 All three types of analysis are suited for their own scenario so there is not point
of choosing a particular. Each of them can be chosen per the requirements.
Some services cannot be measured in terms of money so cost effectiveness
analysis should be done. So, services have monetary involvement so benefit cost
analysis can be done. Cost utility is always needed in the long run.

8. List and asses the eight steps in conducting benefit-cost analysis, cost-effectiveness
analysis, or cost utility analysis.

Steps of Cost Evaluation:

1. Identify Study Objective:
In this step, objective analysis is listed. This includes all the necessary requirements
of the organization from these investments. It involves identification of goal or type
of benefit which organization is looking for.
2. Specify Alternatives:
In this step, all the possible alternatives are specified based on the requirements.
From these alternatives, one which fits best for the purpose is chosen.
3. Develop a framework for analysis:
A framework based on the working of the product is developed. This helps in easily
identifying all the transactions whether direct or indirect being done by the product.
Thus, it ensures knowledge of all sort of cost invested in it along with the benefit
provided by it.
4. Measure Cost:
Now cost measurement analysis should be done, it measures all the costs imposed
on the system. Measured cost also includes all the direct as well as indirect costs.
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5. Measure Benefits:
After cost measurement analysis, measurement of benefit should be calculated, if
the framework is designed properly and all the costs are identified, it becomes
easier to identify these benefits.
6. Factor in Lifecycle and Discounting:
After the complete measurements, the measurement data is first brought into
analysis based on lifecycle of the system. In other words, the functionality of
efficiency of the system is compared with the previous data and work pattern is
identified.
7. Dealing with Uncertainty:
Uncertainty regarding the benefits based on cost incurred is always present it is
never possible to be sure about the amount of benefit based on the cost invested.
This uncertainty however is managed to some extend by sensitive analysis in which
best case and worst case scenario is identified.
8. Considering Equality:
Quality study of cost and benefit should be completed. This includes study of who is
investing the cost and who is getting the benefits. It works on the principle to
provide the equal benefit of all the people involved or attached with the
organization.

9. What is value realization? In what ways is it similar and different from economic
evaluation techniques?

Value Realization and Economic Evaluation:

 The term value realization can be defined as the value or benefit extracted from
the system for which investment was done. The present framework works on
optimizing the value realization as a benefit to the organization.
 It helps users in measuring, monitoring, and maximizing the realized value. This
approach is adjusted in accordance to have better decision making.
 It is almost like other economic evaluation techniques in the manner of
evaluation and analysis of system for profit. It is however different in the
manner of its working.
 It does not evaluate benefits along with cost in monetary terms. Neither has it
analyzed the quality of work and its life time. It just extracts the benefits form
the system as per the investments.
Questions proposed by IT Governance Institution and their importance:
1. Strategic Question: Are we doing things, right?
These questions are asked in order to assure that the investment being done is going
at the right place. The invested object would satisfy our strategy or requirement or
not. Will it improve the business and will it be efficient or consistent with
organizational rule?
2. Architectural Questions: Are we doing it in the right way?
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This question ensures that the investment does not affect the rule or the
organization and consistency of it principle is assured. It assures that the major
architecture of an organization working should not disturb.
3. Value Question: Are we getting benefits?
It is the most important question regarding value evaluation. It assures that the
investment incurred is not wasted and the value of benefit is estimated according to
this question which may be more or less depending on the quality of work.
4. Delivery Question: Are we getting it done in right way?
This question assures that organization has enough management force that it could
easily handle the change that would arise due to this investment. It checks the
effectiveness of management in terms or delivery and change management.

As seen clearly these questions are totally based on evaluation of how the
investment is going to affect the organization. These questions check everything
that would affect the organization due to the investment and also which would
improve the value or benefits of the investments. Hence, these questions are very
significant from the investment point of view.

10. Describe how the nature of the HIT investment application affects the quality and
nature of the value determination.

IM/IT Investment Application affects the Value Determination:

The nature of IT/IM investment is specific to patient and organization. Following are the
details of each of these two types of investment and how they affect the value and
quality.

 IT/IM Investment on Patients:

When Investment is done with reference to patient, its main aim is to
improve quality to service being provided to patients. It includes introduction to
electronic health records, documentation of treatment for its betterment next
time, etc.
The quality of service is such investment is undoubtedly improved. The
value or benefit in such investment is derived from patient’s safety. This
increases the customers and has benefit in this way.
 IT/IM Investment on Organization:
Such investment is used for improvement of the management service
organization. It affects the organization by improving knowledge. It improves
working without actually increasing labor.
It helps in the enhancement of management and decision making. The
quality of service is dependent on how better the management is done and the
value of the investment is also the result of betterment of management.
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Exhibit 13.2 -Technology Cost and Outcome Effect Decision

Matrix
Cost Effect Outcome Effect
Improve No Change Worsen
Increase 1???? 2 Never 3 Never

No Change 4 Always 5????? 6 Never

Decrease 7 Always 8 Always 9?????