Ambulatory EHR implementation project management components

By Jodi Holman

Applying traditional project management methodologies to an ambulatory EHR implementation often yields unexpected and often unpleasant results. Why? Lessons learned in Project Management Professional (PMP) certification can't account for the unique, inherent elements that exist in an ambulatory EHR implementation environment.

"The EHR team must know how the practice works and take on the cumbersome task of setting expectations at every juncture of the implementation process," says Lisa Valenti, Program Manager, Corporate IT at Continuum Health Partners, a non-profit hospital system in New York City and a Concordant client. "It's a daunting task. Each project becomes a microscope into the inner workings of the healthcare environment as these projects tend to span organizations. When governance is not clearly defined, it makes an already difficult project that much harder."

Ambulatory EHR Implementation Project Management Components

The following four key components -- typically taking different forms in an ambulatory EHR implementation -- should be well structured prior to implementation.

Project Governance

Project governance in an ambulatory EHR implementation is usually comprised of a hospital's -- or many hospitals' -- senior management along with physician organization(s)' and affiliated practice(s)' leadership. It resembles more of a community than a typical internal governance structure.  It is important to address who has authority when questions arise regarding balancing standards versus addressing individual practice personalization.  Organizations need to understand how they are to control costs and make such decisions.

Successful structures typically incorporate all aspects of EHR implementation: clinical, technical subgroups, and an overall governing board representing stakeholder leadership. Clearly defining the mission of each group, roles, responsibilities, decision-making authority, and rules of engagement is critical. Without clear expectations and stringent guidelines in place before the implementation starts, misalignment occurs accompanied by delays, additional costs, and few implemented providers. Some organizations set boundaries, defining what each implementation will entail for services, costs, and timeframes. If a practice or group wishes to do something differently, they pay for it.

Project Management

The importance of scope and assumptions are magnified in an EHR implementation. You need to consider the enterprise and each individual practice.  You may have a standard lab interface coming from each hospital but also have a practice in need of a local lab. Do you allow for both? Are these bi-directional? How do you reconcile the lab compendiums? Does this interface require changes or a new Master Patient Index and lab strategy?  Scope and assumptions are complex and can alter timing, costs, and the success of your EHR program. As painful as it is, allot the time up front to carefully consider these decisions.

A solid EHR communication plan identifies stakeholders, communication frequency, and areas to be updated or escalated. Decision-making should be clearly identified. Governance should support communication and be an active participant. Venues of communication are critical. Sending emails to practices not yet implemented may not be practical. Instead, evening "town meetings" at the practice location may be a better source of critical communications.

Clinical and Technical Standards

Another aspect of EHR management that differs from typical project management: when do you create standards or personalize at the practice level? The need for personalization is much higher than most projects. How do you accommodate this task in planning? Clinical standards like critical data capture required for quality reporting may be entered on two separate screens by two practices, the coding behind them being the same. Do you need to have the same exact data capture screens? Inconsistent technical standards cause a support nightmare. Have you ensured software versions, configurations, and network set-ups are all consistent, yet take into consideration practice-specific needs?

Financial Management

Variables in cost management, the change management process, and senior-level approvals regarding finance decisions are critical elements that can cause concern during the EHR project lifecyele.  Project managers are tasked with the burden of presenting budgeting scenarios to senior management.

We recommend that you perform a validation assessment to understand where your organization's implementation project stands. This ensures all areas and sub-categories of the ambulatory EHR implementation components are considered.

Core education from PMP certification, coupled with the "multi-dimensional thinking" necessary for ambulatory EHR implementation, helps project managers embrace this seemingly insurmountable task with greater ease. It enables project managers to fully consider the needs of the enterprise and practice levels, and have a stronger understanding of proper staffing and resource formulas. It ensures a strong communication network between teams and most importantly, solid project governance to address the myriad concerns and obstacles threatening to derail an implementation project.

Jodi Holman is Practice Lead, Program Management at Concordant, which provides healthcare IT consulting services, specializing in ambulatory EHR adoption and implementation.

Copyright © 2010 IDG Communications, Inc.

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