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The Art of the Project

April 1, 2008
by Mark Hagland
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Healthcare CIOs are under enormous pressure to manage a growing portfolio of ultra-complex projects

Ten years ago, when the CIO role was first coming into focus, getting staff, budget funding, and executive management buy-in for IT implementations were the most immediate concerns. Nowadays, when most CIOs no longer have to justify their positions or their department's functions, the landscape has shifted considerably.

Instead of having to justify their responsibilities, CIOs now have to rationalize how their department works, as end-user stakeholder groups bombard them with implementation requests. What's more, the growing industry-wide recognition of the need to quickly begin implementing core clinical information systems — including EMRs, CPOE, eMARs and PACS — is forcing IT departments to ramp up their efforts more aggressively than ever before. How to make sense of the competing needs, demands and priorities?

The solution that healthcare CIOs have hit upon (but which has long been known and used in other industries, particularly is manufacturing) is project management, along with its corollary, portfolio management. (Sometimes, confusingly, the overall concept is also referred to as project portfolio management.)

Different experts define the terms differently, but the bottom line is a simple one: as healthcare CIOs (like their non-healthcare counterparts) are faced with growing demands, increasingly complexity of implementations, and a diverse rainbow of priorities, they are planning projects in advance. More and more they are scoping out their parameters, resource needs, and estimated timelines. This planning is becoming a necessity rather than a luxury.

In many progressive hospital-based organizations, every IT project is being developed in this way. Projects are going through careful planning, approval by committees or a formal project management office, or both, and then being put into a coordinated queue. Some executives are also creating the umbrella concept of portfolio management around this, meaning that they are evaluating potential projects in the context of overall strategic priorities.
David Muntz, senior vice president of information services and CIO, and Nayan Patel, corporate manager of portfolio management Baylor Healthcare System

David Muntz, senior vice president of information services and CIO, and Nayan Patel, corporate manager of portfolio management Baylor Healthcare System

Consider the following examples:

At the 14-hospital Baylor Healthcare System in the Dallas metropolitan area and northern Texas, not only has the IT organization created a formal portfolio management office with a portfolio management director; it has trained and had certified all of the IT professionals in that office in formal project management methodologies. The organization has also created a formal information services governance committee (whose members include the Baylor system's CFO, CMO and CNO, in addition to the CIO) whose responsibilities include approving any project with a price tag over $100,000. David Muntz, Baylor's senior vice president of information services and CIO, and Nayan Patel, the corporate manager of portfolio management who runs the PMO, say that developing the process and staff has led to enormous breakthroughs in efficiency and cost-effectiveness when implementing information systems across Baylor.

Matt Ebaugh

Matt Ebaugh

At the University of Texas M.D. Anderson Cancer Center in Houston, vice president and CIO Lynn Vogel, Ph.D., and Patti Layne, director of project support and coordination services, say that the conversion of the entire M.D. Anderson Cancer Center organization to project management principles has rationalized IT investment tremendously. Like their colleagues at Baylor, the M.D. Anderson folks have created a PMO (there called a project management office), hired a formal director (Layne), trained a cadre of project management professionals within IT, and structured a detailed, formalized governance process around it all. CIO Vogel says it has helped everyone in the organization to think more productively and effectively about IT investments as a whole. And Layne notes that, in the four years since the whole process began, the efficiency of IT implementations has improved dramatically. At the outset, she reports, IT projects had been running 107 percent over baseline, meaning that a project anticipated to take 12 months to complete was taking more than 24 months; and projects were incurring an average 29-percent budget overrun. Within two years, projects were running 7 percent over schedule, were running under budget by 4 percent, and only half required scope changes, compared to 90 percent previously.

Some hospital-based organizations are implementing project management principles, but in less orthodox ways. For example, Matt Ebaugh, vice president and CIO at the 300-bed Silver Cross Hospital — a freestanding community hospital in Joliet, Ill., a southwestern suburb of Chicago — two years ago began to establish a project management office, which went live a year ago, and is staffed by a project coordinator.