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Project Management
How Do I Get From Here to There?
The Role of Project Management in Your EHR
Implementation
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Objectives:
Identify 2-3 phases of an EHR implementation

Identify 2-3 critical leadership issues for a successful
EHR
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Project Management
Two Rules to Live By:
If you dont know where you are going, any road will
get you there.
All systems are perfectly designed to achieve the
results they deliver
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Project Management
What is a project?
A temporary endeavor undertaken to achieve a specific
aim
In this presentation, we will focus on a particular
project: the successful implementation of an EHR in
your practice
What is project management?
Project management is the application of knowledge,
skills, tools, and techniques to project activities to meet
project requirements. (PMBOK, 2003)
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Project Management
A project is comprised of phases:
Each phase is defined by completion of one or more
deliverables
Deliverable = a tangible work product
The project phases of an EHR Implementation look like
the EHR Roadmap:
Assessment
Planning
Selection
Implementation
Evaluation
Improvement
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Project Management
Roadmap also follows
the PDSA cycle:
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Assessment
Assessment
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Assessment
Assessment phase is comprised of:
Developing a project charter
Determining budget
Creating a project team
Aligning the organization to the projects goals
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Assessment Project charter
Developing a project charter
A charter documents what you plan to accomplish:
Organizations vision and goals
Scope
A good scope details not only what is included in the
project, but also what is specifically excluded from the
project
Benefits
ROI as well as ROE (return on effort)
Tangible and measurable, as well as soft benefits
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Assessment Budget
Determining your budget
Realistic expectations of cost:
EMRs cost $15-50K per provider
(based on AC Group - 7/15/04)
What is your cost tolerance?
What are you willing and able to spend?
While the budget doesnt need to be exact, you do need at
least a ballpark figure:
- Very robust solution = large investment and transformational
change $$$
- Superior solution = more incremental change, keep it close to
the current practice $
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Assessment Project team
Creating a project team
Leadership:
Financial staff are partners, rather than drivers
Clinical projects should be driven by clinical leaders
Having an EHR champion is critical to project success
EHR champions are:
Communicators
Teachers
Respected peers
But not necessarily the most computer savvy staff
Executive leadership is key
Broker the partnership between the clinical staff, business
staff, and vendor
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Assessment Project team
One role does not necessarily equal one person
In smaller organizations, one person may share more
than one role
In larger organizations, you may find that some roles
are split over a few specialists
Honest evaluation of implementation skills in the
practice
Has anyone led an implementation before?
Has anyone tested software before?
Has anyone taught staff before?
Who can handle the tech issues?
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Assessment - Other
Aligning organization to the project goals
Share the charter with the team
Recognize that changes may be required based on
feedback from other members of the practice
Consider adding to the project team staff who have
strong opinions about the project
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Assessment
Deliverables at the end of this milestone:
DOQ-IT application and needs assessment completed
Project Charter written and communicated
Vision and Goals
Budget estimate
Benefits
Project team identified
Current workflows documented and evaluated
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Planning

Have you ever
had this
nightmare?
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Planning
Now that the project has been defined, its time to put
together a plan
Supports your project scope
Develops a structure for the project
Steps in developing a project plan:
Develop a timeline
Outline the key milestones and deliverables
Gain support with key stakeholders
Initial research for vendor selection
Develop an implementation model
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Planning Time Line
Develop a time line
Based on DOQ-IT experiences, the following time
frames are a good estimate of the time needed for an
EHR implementation:
Vendor selection (1-3 months)
Contracting (1 month)
Implementation (2-4 months)
Training and Go-Live (2 weeks)
Consolidation of gains (3-9 months)
Evaluate (1 month)
Improve (On-going)

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Planning Milestones and Deliverables
Outline the key milestones and deliverables
This task will bridge the Planning and Selecting
project phases.
In the planning phase, you only need to develop broad-
brushstroke of the key milestones
More planning will need to be done at each additional
phase, but it is important to put together a framework
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Planning Gaining Support
Gain support for the project with key stakeholders
Identify stakeholders
Importance of communication
Communicating about the project is easier and more
comprehensive if you develop a communication plan
Staff meetings
Newsletters
Announcements at meetings with other stakeholders
Materials should be directed to a specific audience
Frequent updates
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Planning Preparing the Groundwork
Vendor selection is a balancing act
Vision and
culture
Budget and
resources
Cost and
complexity of
the EHR
implementation
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Planning Preparing the Groundwork
Prepare for vendor selection
Vendors: 250+ 10 5 2-3 1
Preliminary research (250+ 10 5) leads to a short
list of vendors
Trade shows
DOQ-IT
Web research
IPA/PHO recommendations
Local vendor presence
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Planning Preparing the Groundwork
Vendor Selection
Request for Information (RFI) / Request for Proposal
(RFP) process
RFI is usually more informal than an RFP
Standardized approach to collecting vendor information
Ability to use a rating and weighting system to help with
the selection process
Many communities submit a collective RFI/RFP
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Planning Preparing the Groundwork
Completed RFI/RFP is submitted to short list of
vendors
Lot of information to go through
RFI/RFP process is taxing for vendors
Short list of vendors can then be narrowed down to
2-3 finalists
These are the vendors who will return for
demonstrations
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Planning Implementation Models
Developing an implementation model isnt as simple
as deciding when to turn the computers on
A few important decisions to make:
Multiple sites
Big Bang vs. incremental
Managing productivity losses
There is a way to push productivity losses near zero
dollars - there is also a way to reduce the time during
which productivity is down to near zero days
These are not the same plan
You need to balance acceptable productivity losses
with the length of the transition, implementation, and
training period
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Planning Implementation Models
Managing multiple sites
Consider starting with a smaller pilot site
Test workflow redesign ideas
Proof of concept for the rest of the group
Take advantage of smaller group of enthusiastic
providers
Bring all sites up together if a primary goal of the
implementation is to reduce chart runs between sites
Let organizational goals drive the implementation
Instant productivity gains from reduced chart runs will
offset productivity losses elsewhere
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Planning Implementation Models
Incremental vs Big Bang
Selecting appropriate implementation strategy one of
most important decision practice will make
Each style has its merits
Detailed projects plans will increase the chances that
the implementation succeeds
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Planning Implementation models
Patients
Start with one patient on the first day,
and document the entire visit. Add a
few patients per day until the whole
panel is on.
Providers
Let your most enthusiastic provider
start. Add one physician per week
until even the pessimists are up and
running. (Works out the kinks for the
reluctant physicians.)
Modules
ePrescribing, CPOE, Patient-
physician communication tools,
disease registry, full visit
documentation, etc.
Functions
Phone calls, prescriptions, billing,
injections, labs, full visit
documentation, etc.
Ways to implement incrementally:
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Planning Implementation models
Pros:
Great for building
groundswell in practices
where there is not a pro-
EHR consensus
Can prevent productivity
losses
Limits implementation pains
to one group or function at a
time
Allows for plenty of time to
fix kinks in workflow and
process changes

Cons:
Potential for getting stuck
partway through an
implementation
Can be exhausting
imparts the feeling that
things are always in flux
Hybrid paper/EMR system
is confusing
Incremental implementation
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Planning Implementation models
Pros:
Great for small practices
where all providers are
excited about the EMR
Takes advantage of
enthusiasm
Shorter implementation
No paper/EMR hybrid issues
Cons:
Higher chance of failure
Does not allow for time to fix
kinks in workflow, network
issues, or technical glitches
Significant productivity
losses
Workflow glitches can
provide a reason for
providers non-adoption
Big Bang implementation
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Planning
Deliverables at the end of this milestone
Timeline for the project
Rough list of key milestones and deliverables based on
your vendor selection process and implementation
model
RFI or RFP developed and a process for your EHR
vendor selection
Communication plan
Clinic staff
Other stakeholders
Preliminary meeting with key stakeholders on
implementation models

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Selection
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Selection
Selection phase consists of three types of tasks:
Ongoing planning tasks
Execution Tasks
Finalize vendor selection
Make hardware choices
Negotiate the contract
Prepare the office space
Controlling Tasks
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Selection Ongoing planning
Ongoing planning tasks
Continue to develop the key milestones and
deliverables
Not necessarily a linear progression
Need input from your selected vendor to complete this
process
Complete the practice assessments of workflow and
office space
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Selection - Execution
Execution Tasks
Finalize vendor selection
Moving from the RFI/RFP process Vendor
demonstrations
Need to examine the product in two different ways:
Structured demonstrations address the concerns and
requirements of your practice
Vendor driven demonstrations showcase the software
product
DOQ-IT has vendor evaluation tools when you are ready
to begin the process of rating
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Selection - Execution
Reference Checks
Two options for checking references site visits and
telephone calls
In either case, you will get the most out of your efforts if
you:
Select a site that is a good match for your size and type of
practice
Use a structured tool for evaluation of a site
Send this tool to the site, allowing them to highlight your
areas of concern
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Selection - Execution
Negotiating a contract
There are many aspects to contract negotiation
Training
Implementation
Hardware
Third-party software
Technical support
And many more
The contract that the vendor gives to you will protect
them you want to review the contract so that it
protects you
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Selection - Execution
Expectations of your vendor
The level of vendor assistance in project management
will depend on your contract
The amount of implementation support
offered/available/recommended varies wildly by vendor
If your vendor provides assistance, review their project
plan to verify that it matches your needs
If your vendor does not provide assistance, all the
responsibility is shifted to your practice

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Selection - Controlling
Controlling Tasks
What is scope creep?
Uncontrolled changes to a projects scope
Usually results in a project overrunning its budget and
schedule
The scope creeps by adding new products, features,
functions, or goals
Some scope creep should be expected
Inevitable result of originally lean budgets and schedules
Important to identify which cost/schedule overruns are
acceptable and which should be left for another project


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Selection - Controlling
Control of scope creep
Establish a change control process
Team should review all requests scope changes to
determine how each request affects the project:
Schedule
Budget
Resources
Benefits of the change
Change control is a process that will be critical in all
subsequent phases of the EHR implementation
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Selection
Deliverables for this phase
Ongoing planning tasks
Completed current workflow and office space analysis
A complete list of all needed tasks, milestones, and
deliverables for the vendor and the practice
Execution tasks
Vendor demonstrations
Selection of a vendor
Negotiated contract with the final vendor
Controlling tasks
Changes to scope are documented and reviewed by the
team before they are accepted

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Implementation
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Implementation
Implementation phase consists of three types of
tasks:
Ongoing Planning Tasks
Execution Tasks
Sign a contract
Do the work
Controlling Tasks

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Implementation Ongoing planning
Now that you have an implementation plan from the
vendor, you can finish the project plan
Include expected dates for all milestones
When setting milestones and outlining deliverables, be
sure to manage both the responsibilities of your
practice and the vendor
If they miss a deadline, it is your practice that will suffer
Assigning resources to each task and deliverable will
allow other team members to begin working on the
project
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Implementation - Execution
Execution Tasks
Sign the contract
If your vendors implementation resources are heavily
taxed, you may not want to delay this step
Each day you delay will push your implementation date
out by more than a day
Communicate to stakeholders
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Implementation - Execution
Do the work:
Install the hardware and software
Install the network and peripheral systems
Convert data from old systems to new system
Test and implement interfaces
Chart abstraction
Develop plan for chart abstraction
Begin the process of abstraction before Go-Live
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Implementation - Execution
Do the work (contd):
System testing
Network
Interfaces
Hardware
Software
Training
To augment vendor training, ask your vendor for
additional training opportunities
Could include training CDs, online resources, dress
rehearsals, test patients, and remote login
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Implementation - Controlling
Controlling Tasks
Continue to control scope creep
Scope is most likely to creep in this phase of the
project
Including more participants in the process
The full resource requirement of each task will be more
obvious
Monitor progress of tasks both vendor and practice
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Implementation
Deliverables for this phase
Planning Tasks
Working project plan that includes all of the tasks,
milestones and deliverables
Execution Tasks
Signed contract
Regular communication with stakeholders
Clinic staff
Patients
Other entities
Work as listed above

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Implementation
Deliverables for this phase
Execution Tasks (contd)
Go-Live plan completed
Go/No-Go meeting date set
Chart abstraction
Reduction in schedules
Implementation model decided and expectations
communicated
- First practice to go
- Big Bang vs. incremental approach
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Implementation
Deliverables for this phase
Controlling Tasks
Any changes to the scope of the project are reviewed by
the team before being accepted
The project manager and team meet regularly to monitor
progress
Anticipated missed milestones or deliverables are
discussed
Mitigation plan in place

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Evaluation
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Evaluation
Evaluation begins after the Go-Live day
You may find evaluation on the first day to be a bit
taxing
Begin evaluating the project as soon as you can
discern patterns emerging
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Evaluation
Execution Tasks
Continue with your communication plan
Conduct additional training as needed
Initiate a plan for training new hires
Conduct a post-implementation audit/survey of
selected stakeholders

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Evaluation
Controlling Tasks
Evaluate evolving practice performance against the
benefits and ROI defined in your project charter
If benefits have not been realized
Evaluate the expected benefits: Were they realistic? Can
they still be realized?
Was the implementation effective?
What steps can you still take to realize the project vision
and goals?
Re-examine your scope to identify any changes that
were not part of the original plan
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Improvement
Improvement
Improvement is an on-going component of the process,
and can be seen as the beginning of a new PDSA
cycle
What else can you do to improve office efficiency and
productivity?
What else can you do to improve patient care in your
practice?
Use of evidence based guidelines
Participation in P4P programs
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Did We Meet The Objectives:
Identify 2-3 phases of an EHR implementation
Identify 2-3 critical leadership issues for a successful
EHR