United States

Strategic Project Management Key to Health Care Technology Advances

INSIGHT ARTICLE  | 

Health care organizations continue to move towards modernizing their capabilities to provide better care and enhanced operations, resulting in a surge of health care technology transformation initiatives to address these improvement efforts. Some of the common transformation initiatives often include programs such as implementations or replacements of electronic health record (EHR) systems, clinical systems, enterprise resource planning (ERP) systems, technology consolidation initiatives and data center migrations. Although the volume of large technology transformation projects continues to grow, health care transformation success stories are few and far between. According to HealthIT.gov data, there has been a doubling of EHR adoptions and implementations over the past 10 years. As a result one would expect that, with the sheer volume of implementations and the iterative learning from these initiatives, the probability for successful implementations of health care technology projects would have improved. In reality, though, we more often see an expansion in fees, timelines and missed expectations with end users. Organizations continue to struggle to get it right the first time when implementing health care technology solutions, and frequently the lessons learned from these failures point to a common trend. The leading reason for not meeting the desired outcomes is poor planning for the program deployment at the start. 

Health care leadership, system vendors and implementation consultants hold equal responsibility for program outcomes. It is important for all parties to jointly spend time on planning for the program, and consider the common pitfalls for such complex solutions. It is valuable to understand the planning process, and the focus on downstream activities, as these combined elements have a significant effect on the success of health care initiatives. 

In our experience at RSM, having been part of several large technology integration projects, some of the common areas that teams struggle with is planning for downstream activities that are complex to estimate. These planning activities often get differed to a later stage, and sometimes get missed as the project execution phases are initiated. It is recommended that leadership blueprint the considerations listed below as part of the planning steps, and set objectives to organize teams, budgets and processes for each of them. Some of the reflections listed below are fairly complex to plan for at an early stage, however they need to be identified in order to minimize surprises in the future as they could significantly affect budgets, timelines and functionality as the project continues to get executed.

Strategic topics at the program planning (initiation) phase

Some areas for consideration that health care leadership should think about during the planning stage of the project in relation to project definition, implementation and maintenance phases are highlighted below.

Program definition planning

Define organizational need

  • Define a clear picture of underlying vision and business need of the future system with input from department stakeholders
  • Enable transparency for department leads to determine system size and capabilities
  • Avoid high levels of system customization during project execution, which could result in delays, increased costs, user dissatisfaction and more complex maintenance models

Identify key stakeholders

  • Identify key stakeholders from the business, operations and technology areas at an early stage of the project lifecycle
  • Involve key stakeholders in vendor selection, project planning and system design
  • Understand that failure to identify and involve key stakeholders early on can result in project delays due to changes in scope and resource assignment as well as poor operational buy-in  

Outline preliminary requirements

  • Define the preliminary requirements of the future solution in the planning phase in alignment with the business and clinical needs of the organization
  • Understand that these requirements will help identify the proper solution for the organization’s needs as well as provide a basis for vendors to provide an educated response to request for proposals

Strategically select vendor

  • Know that system vendors vary significantly in the role they take on and the support they provide during an implementation
  • Define scope precisely as different vendor solutions may have varying levels of integration with both existing and future systems
  • Set clear expectations about vendor involvement and roles in the implementation during contract negotiations that are based on strategic needs of your organization

Identify peripheral system impacts

  • Identify software and hardware incompatibilities and integration points for peripheral systems and the new solution 
  • Evaluate the costs and timelines for integrating the new system into the existing software portfolio
  • Consider resources and time for integration work needed for the new solution and existing solutions

Set up independent project management and quality assurance (PMQA) monitoring

  • Consider creating an independent monitoring team that reports to senior management about progress, risks and mitigation strategies, focusing on PMQA
  • Develop a model that would independently identify risks (and report to leadership) associated with the implementation and provide controls and oversight to mitigate those risks
  • Obtain independent insight to help leadership understand changes to systems, infrastructure and business processes

Implementation planning

Define governance model

  • Develop a strong governance model as project success depends on it
  • Structure the steering committee with executive leadership and key stakeholders from areas affected by the project, including technology, operations and the parts of the business utilizing the new solution
  • Bring all stakeholders to the table allowing them to make effective decisions quickly when questions and issues arise

Define project management office (PMO) and identify program manager (PM)

  • Engage an experienced PM and define a structured PMO as they are crucial to a successful implementation and should be set up prior to the vendor being brought on board
  • Define processes and guidelines before the implementation begins, allowing the vendor to hit the ground running when the project is initiated
  • Setup a robust PMO to make it easier to track project progress and identify areas that are off track

Set outcomes and goals

  • Set up realistic and achievable goals for all involved lines of business to track project progress
  • Avoid setting unrealistic goals even though they may seem attractive at first; consider the cost of not meeting unrealistic goals during project execution
  • Track key performance indicators before, during and after the implementation to ensure that expected improvements and operational goals from the new solution are realized

Prepare for change

  • Prepare for change as software implementations bring about significant disruption to operations and day-to-day workflows
  • Obtain buy-in not only from department leaders but key managers and superusers within the user community, and build a culture of adoption
  • Leadership should maintain a deep level of operational involvement throughout the implementation to fosters an environment where process changes are more successful

Detailed testing and verification

  • Develop a test plan to include every utilized component of the new solution as well as any related systems that are affected
  • Acknowledge that issues identified later in the implementation process are more expensive to resolve than those identified earlier
  • Test everything as this leads to a high confidence level at go-live and fewer unexpected issues are revealed

Transition to support, and maintenance and operations planning

Prepare for support model

  • Strategically plan for support and consider people, process and technology; a high quality support model for a large system requires significant investment and planning
  • Train staff early; staff who are supporting the new solution must have the appropriate skill set and training and be involved with the design and build
  • Understand that outsourcing some or all support tasks is an expensive proposition that requires considerable thought, planning and management

Plan for support costs

  • Plan for support budgets and develop a holistic long-term support plan; the selected support model will add to annual costs for the new system and budgets will need to be planned for
  • Plan to train internal support resources to maintain the new solution and consider that it requires investment of time and funds on an ongoing basis
  • Consider costs associated with software licensing fees and infrastructure maintenance and replacement; define and analyze inventory

Budget for training end users

  • Strategize for a robust training plan and budget for it in advance; do not take this lightly as it is a common point of failure on large initiatives
  • Consider the cost of workers not using the well-defined processes and technology, and its impact to operations
  • Invest in training, tools and resources to get it right the first time

Conclusion

The right level of upfront planning for a large health care technology integration can help senior leadership manage timelines, budgets and resources more effectively. The points made above touch on the foundation of planning items required for a successful implementation, and are intended to spotlight the typical pitfalls that lead to extended timelines, expanded budgets and resourcing shortfalls. Effective project planning, executive engagement and informed decision-making will significantly improve the probability of project success.

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