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Getting off to the Very Worst Possible Start — Don't do it!

November 15, 2009
by James Feldbaum
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I’ll make this short: Don’t start with a time-line! Almost universally every RFP for an EMR/CPOE that I evaluate already has a time-line. Sure, maybe there is a desire to meet certain benchmarks tied to reimbursement, but what makes you think you can meet them? It is like fixing a time-line for climbing Mount Everest without knowing the climbers, their climbing skills or accounting for the worst weather on the planet. Like Everest, most attempts fail to reach the summit; there will be serious casualties; and the majority of attempts fail before even reaching high base-camp.

Find a consultant that you trust. Perform an in-depth readiness assessment; agree on a realistic vision for both the immediate term and the long term; have your own committed sponsors ready to work with your consultants; and move at the speed of success. It is fair to set time goals, but not carved in stone. I am not sure if I have ever seen a pre-project time-line that was achievable. The goal is to reach the summit in one piece not on a particular day.

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Yes, I too have witnessed total loss of momentum. I actually have an article in Healthcare Informatics making a case for a mandate. My only gripe is with the pre-evaluation time-line which is generally naive and arbitrary. I have witnessed an administration judge a CIO's competence based on meeting an impossible and unrealistic schedule.

Great point, Jim.

Another byproduct of an unrealistic timeline is that Quality Assurance and end user, pre-go-live testing always gets cut short. In some cases, eliminated. And with predictable consequences.

Some organizations write their contracts such that both the hospital and the vendor seem to want to deliberately skip testing to insure they make their dates.

Objectives of performing a readiness assessment vary from organization to organization however, there are a few objectives that most organizations would desire prior to the beginning of a system installation.

The primary objective is to determine the risks that are present that may impact the degree of success you achieve with your investment. A few examples that should be reviewed prior to implementation are:

1. Organizational Initiatives — Why are you investing in technology and what specific objectives do you have as an organization?

2. Organizational Design — How is the organization structured to manage implementation and change? Who will make the decisions and be responsible and accountable for achieving the organizationa l initiatives?

3. Scope — Has the organization defined a specific scope for the project and, more importantly, how will the scope be managed as the project moves forward?

4. Resource Allocation — Are there adequate resources to install the system, manage the day-to-day operations and maintain the legacy system?

5. Change Management — Who will identify and manage the changes that will be required for optimal success? How will this occur? Who will ultimately be responsible and
accountable?

Agreed - there is much wisdom in not tying an organization down to unrealistic or unachievable time-lines for EMR implementation "just because", but I also see a benefit to trying to adhere to a somewhat aggressive and well-defined timeline. An EMR implementation is so big and so all-consuming, that if you don't put an organization's feet to the fire to go all-hands-on-deck in implementing the EMR, you run the risk of succumbing to what I would call "organizational A.D.D.", where other things start wafting up and you never get the ball completely down the field.

Just another thought process i wanted to put out there for brainstorming.

James Feldbaum

Jim Feldbaum is a physician consultant specializing in clinical transformation, CPOE, and...