Project Management of Implementation

Stages of implementation

As with any large project for a business, a project plan is essential to contain the scope of the project. With any EHR implementation, extensive planning must be done to create the infrastructure, data framework, and configuration before the system is turned on. Using Verzuh's <ref>Verzuh E. The Fast Forward MBA in Project Management. Fourth Edition. Hoboken, New Jersey: John Wiley & Sons; 2012. [1]</ref> An entire project plan should include:

• Infrastructure
  • Workspace modifications
  • Wiring and cabling
• Configuration of hardware, servers, clients, and peripherals
  • Operating system installation
  • Security policy
  • Staffing: IT consultants or staff to maintain the network and hardware.
  • Installation of PHP, MySQL, Apache, and default instance of OpenEMR
• Data framework
  • Patient demographics, if available from another system
  • Billing and coding tables
  • Insurance company contact information
  • Existing clinical data from previous system
• Configuration
  • Customization
  • Clinical forms
  • Clinical decision support

An example project plan from an actual implementation project is outlined in this wiki. Every transition will be different. Some notable characteristics of this clinic's project:

• The previous record system was paper charts.
• The clinic is maintaining its own network and data storage in house.
• Billing is outsourced, and a file of demographic and individual insurance information was available for transfer into the new installation.

Project Charter

Planning the implementation of OpenEMR

Purpose: The purpose of the project is to convert a medical practice based completely on paper records to an electronic health record and practice management software package. The scope of this project as a stage in the implementation is to create a framework of data in the software, initiate the process of scanning the paper, and developing a full project plan.

Statement of Work

Scope:
Major project activities

• Workflow analysis
• Privacy analysis
• Workspace modifications
• Equipment allocation
• Wiring and cabling
• Installation of software
• Security analysis
• Population of lookup tables
• Import demographic data
• Labor allocation for the scanning tasks
• Redesigning the information flow with the billing company
• Configuration
• Training
• Implementation

Out of scope activities vital to project success:

• Plan for adding new workflows
• Participation in the development of the OpenEMR project
• Reporting
• Certification for Meaningful Use

Deliverables:

• Privacy assessment
• Workflow analysis
• Lookup table population
• Security assessment
• Paper scanning workflow
• Training manual

Cost estimates:

Cost type	Amount
Labor
Equipment

Schedule overview:
Major milestones

• Completion of privacy assessment
• Completion of workflow assessment
• Population of database with lookup tables
• Completion of security assessment
• Resource and labor allocation for the paper scanning
• Training plan

Impact of late delivery: Delay in full implementation plan and implementation date.

Completion date:

Measures of success:

• The foundation is laid for the EHR to be used meaningfully
• The stakeholders have buy-in
• The practice within six months performs at least as efficiently as it did prior to the project.

Stakeholder Analysis

Identified stakeholders:

• Physician practice owner/manager
• Practice clinicians
• Nurses
• Practice office staff
• IT manager or consultant
• Patients
• Other practitioners involved information exchange
• Outside billing company
• Transcription service
• Payors
• OpenEMR development community
• Project manager

Stakeholder role profiles:

Function	Stakeholder responsible
Approves funding	Physician practice owner/manager
Functional requirements	Physician practice owner/manager, Practice office staff, IT manager, Project manager, Clinician lead
Technical requirements	IT manager, Project manager
Design decisions	Physician practice owner/manager, Project manager, Clinician lead
Changes to requirements	Physician practice owner/manager, Project manager
Changes affecting schedule	Physician practice owner/manager, Clinician lead, Project manager
Changes affecting cost	Physician practice owner/manager, Project manager
Users of product	Physician practice owner/manager, Practice office staff, Nurses, Practice clinicians, Patients
Sets organizational goals	Physician practice owner/manager
Assignment of people and time	Project manager, Physician practice owner/manager
Sponsor	Physician practice owner/manager
Manager	Project manager
Work disrupted	Practice office staff, Physician practice owner/manager, Practice clinicians, Nurses
Change in system	Practice office staff, Physician practice owner/manager, Patients, billing, transcription
Receives benefits	Practice office staff, Physician practice owner/manager, Patients, billing, payors, development community
Performs work	Project manager, Physician practice owner/manager, IT manager, Practice office staff
Phase gate decisions	Physician practice owner/manager, Project manager, Clinician lead, IT manager

Stakeholder alignments:

Physician practice owner/manager
What is their contribution to the project?	Sponsorship and overall oversight.
To whom do they report?	Reports to regulatory authority.
What authority do they have over the project?	Primary authority.
What is their goal for the project, and how does it relate to the organization's goal?	The goal is to have a meaningfully used EHR. This parallels the organization's goal.
Do they present a specific threat or opportunity?	A successful project will offer an opportunity to share with the development community as well as other practitioners.
What perception is desirable for them to have?	The perception should be one of increased flexibility and productivity while offering optimal patient care.

Project manager
What is their contribution to the project?	The knowledge gained through formal education is to be shared by providing leadership on the project.
To whom do they report?	Milestones are reported to Physician practice owner/manager.
What authority do they have over the project?	The authority is managerial.
What is their goal for the project, and how does it relate to the organization's goal?	The goal is to set the framework and plan for a successful implementation of the EHR, while gaining educational experience. This is parallel to the organization's goal.
Do they present a specific threat or opportunity?	The opportunity is for everyone involved learn from one with experience in managing an implementation.
What perception is desirable for them to have?	The perception should be one of a successful implementation in a well run practice.

IT manager
What is their contribution to the project?	Support for the technical aspects of the implementation and long term maintenance of the software and hardware.
To whom do they report?	Reports to Physician practice owner/manager
What authority do they have over the project?	Technical authority
What is their goal for the project, and how does it relate to the organization's goal?	The goal is to create a more flexible and efficient practice, while supporting open source development.
Do they present a specific threat or opportunity?	The opportunity is present for the open source community to gain knowledge.
What perception is desirable for them to have?	A perception of a secure, private, compliant EHR with complete data ownership is important.

Office manager
What is their contribution to the project?	Operational knowledge and workflow is contributed.
To whom do they report?	Physician practice owner/manager
What authority do they have over the project?	The authority to organize and redesign tasks in the front office.
What is their goal for the project, and how does it relate to the organization's goal?	The goal is to enhance patient care.
Do they present a specific threat or opportunity?	It is possible there will be resistance if it is not clear that the project will benefit the patients.
What perception is desirable for them to have?	The perception should be that the patients will be happy with the new system, and that it enhances their care.

Patients
What is their contribution to the project?	No direct contribution, only patience and understanding.
To whom do they report?	They do not report to a specific entity.
What authority do they have over the project?	They have no organizational authority, but they have the option to leave the clinic's care if unsatisfied with the transition.
What is their goal for the project, and how does it relate to the organization's goal?	Their goal is to receive fantastic customer service, appropriate billing, and most importantly optimal patient care.
Do they present a specific threat or opportunity?	If the project disrupts the process of care, patients may be resistant to change.
What perception is desirable for them to have?	The perception to encourage is that the EHR will make their care better, safer, more secure, and more efficient.

Responsibility Matrix:
E: execution
A: approval
C: must be consulted
I: must be informed of decisions

Activity	Physician practice owner/manager	Project manager	IT manager	Practice office staff
Financial allocation	A, C	E	C	I
Requirement changes	A, C	E	C	I
Communication with billing company	A	E	A	C
Labor allocation	A, C	E	A	C
Privacy considerations	A, C	E	C	I
Security considerations	A	E	E, C	I
Creation of continued project plan	A, C	E	A, C	I

Communication Matrix

Stakeholder	Information Needs	Frequency	Medium	Response
Physician practice owner/manager	Resource needs	Weekly or as needed	Telephone, e-mail, in person	Within 3 days
Project manager	Feedback	Weekly	Telephone, e-mail, scheduled check-in	Within 1 week
IT manager	IT and security needs	Weekly or as needed	Scheduled check-in, e-mail	Within 3 days
Practice office staff	Workflow changes	As needed	In person, telephone	Within 3 days
Patients	Procedure and security changes	As needed	In person	Before procedure or appointment

Risk Analysis:
Risk #1
Responsible person: Project manager
Condition: There is difficulty getting demographic data from the source (billing company)
Trigger event: Billing company cannot compile the data into a usable form
Consequence: There will be no automated way to import the demographic data into the system, and it will need to be cleaned up or entered by hand.
Impact value: 3 of 5
Probability: 20%
Expected value: unknown
Response strategy: In person meeting with billing company IT staff, restructure of data
Cost of response: minimal
Contingency for response: Plan to create a workflow for manual data entry.

Risk #2
Responsible person: Project manager, IT manager
Condition: System is found to be insecure
Trigger event: Security analysis reveals inadequacies
Consequence: Patient data is compromised
Impact value: 5 of 5
Probability: 20%
Expected value: Unknown
Response strategy: Bring in security expert
Cost of response: Consultation fee unknown
Contingency for response: Do not enter PHI until the system is secured

Risk #3
Responsible person: Project manager, Physician practice owner/manager
Condition: Unable to allocate hours to extra labor to scan charts
Trigger event: Unable to bring in extra help if necessary
Consequence: Backlog in scanning
Impact value: 3 of 5
Probability: 40%
Expected value: Overtime wages for office
Response strategy: Competitive wage offer for temporary help
Cost of response: unknown
Contingency for response: All members of team help complete tasks as time allows while being flexible with go-live date.

Risk #4
Responsible person: IT manager, Project manager
Condition: Computer system is down
Trigger event: Equipment failure
Consequence: Lost data
Impact value: 5 of 5
Probability: 20%
Expected value: unknown
Response strategy: Perform backups to standards
Cost of response: minimal
Contingency for response: Rebuild from existing data

Reference:

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