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Work Flow Analysis Helps Physicians Select Ambulatory EMR That Meets Needs

Physicians, EMR Implementations and the Science of Project Management

For those who enjoy the ease and convenience of online shopping or use of self-pay kiosks for everyday activities like purchasing gasoline and groceries, it is hard to understand why medicine has remained so heavily paper-based.   On the other side, those who work closely with healthcare providers during and after technology projects recognize how complex and difficult it is.   Almost two thirds of technology projects fail as they run into problems such as unplanned costs, excessive delays, poor quality, expectations not being met and excessive numbers of unresolved issues.   When such “failures” are analyzed it is common to discover preventable causes such as poor planning, inadequate testing, poor work flow redesign, failure to identify and manage risks, poor communication, faulty implementation strategies, selection of the wrong technology products or the use of good technology in a way it was not designed to be used.   Although there are not simple recipes to follow that guarantee successful health IT implementations, there is a large body of knowledge regarding how best to manage technology projects in general.   A major resource for this knowledge is the Project Management Institute which promotes the science of project management throughout the world.   Although the details of project management are beyond the scope of blogging, there are eight knowledge areas that describe the principles of project management:

Procurement management

Obtain/purchase products and services, contract management, vendor management

Cost management

Budget and monitor costs

Project integration/communication

Objectives/goals, project plan, execution, monitoring status; managing changes; managing internal and external communications;  review/close project

Scope management

Establish scope of work needed, monitor and manage all processes and changes related to scope

Time management

Establish timeline based on work required, resource availability and scope; monitor and manage time constraints and schedule changes

Resource management

Who does what, when, where and how; establish project team; monitor and manage resource constraints and bottlenecks

Quality management

Test the application/product; follow project management principles

Risk management

Risk analysis, work flow analysis, risk mitigation planning, work flow redesign; change management

Understanding the basics of project management is more important for physicians than to understand the technology.  

Before selecting a technology product, these principles direct the physician to first identify the goals (or “objectives”) that are expected to be achieved by using the technology.   Defining the expected objectives allows the physician to then determine what the technology product specifically needs to do (the “requirements”) in order to achieve those goals.  This aligns technology purchases with the physician’s actual needs and expectations.  A common error is to select a technology product first and then figure out how to use it.   The risk with this faulty strategy is that, even if some value is gained, the physician’s actual goals and needs may remain unmet.  

The scope of a project is defined by what needs to be implemented in order to meet the identified goals and requirements.   A project plan and timeline can be created by determining how much work is required, within this defined scope, who is available to do that work (physicians, staff, temporary labor, vendor resources, consultants) and how much time those people have available to do project work.   Project management principles keep technology implementations “on track” by monitoring the scope and maintaining a balance between known work, known resource availability and established timelines.  It is easy for physicians or staff to become enamored with potentially valuable, but initially unplanned, uses of new technology during an implementation.  If these unplanned uses are piled onto the original scope of a project, then there is more work to do.   

The consequence of more work is the need for more people or time to complete the project.   Sometimes the additional work results in unbudgeted costs such as paying a consultant for additional hours to do the unplanned work.   Unplanned “scope creep” like this is a common malady that derails technology projects but can be avoided or contained by adherence to project management principles.  

And finally, an important aspect of project management is attentiveness to policies and procedures.   Policies and procedures that successfully manage risk within a paper-based work flow will become obsolete if technology creates a new electronic work flow.   A comparison of current work flow to future work flow along with a risk assessment during the project will identify needed changes to policies and procedures.

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Since many of our customers sell EMR/EHR solutions, I have been doing some extensive reading on the topic of implementation issues. I spoke with Dr. Peter Polack as well.

This brief blog post may be of some assistance to EMR/EHR vendors when it comes to helping their customers to success.

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