The first components of the hospital EMR went live in January. After much hard work and planning, inpatient results are available in our EMR. Combined with the ambulatory results that have been there for years, the results viewing gives our clinicians access to a complete picture of results for our patients across the continuum of care.
In addition, our anesthesiologists document their pre-operative assessments within the EMR. Our operating room nurses already documented care electronically, but this was the first step in physician documentation in the hospitals. The build has emphasized a graphical user interface that has a “point-and-click” review of history that should be speedy and easy to use for the physicians. It will also automatically bring forward relevant medical history that has previously been documented in the clinic environment for physician confirmation with the patient.
As with the final month before any go-live, activity occurred at a feverish pace. Integrated testing, training and enterprise communication were the major activities. For the results go-live, testing was the most onerous activity. For the anesthesia documentation, user training was the greatest challenge. Ultimately, we had not yet cracked the code on effective enterprise communication and are currently working on developing a project Web site and monthly newsletter for the hospital.
Over the last few months, within our team and our organization, I've simultaneously witnessed a disturbing trend. On our project teams, our staff worked very hard, but had difficulty prioritizing work, communicating status and understanding what needed to be done to achieve major milestones. In the hospitals, given the size and scope of the project, and the incremental roll-out plan we'd chosen, no two hospital managers could tell you what components of the EMR would be implemented and when.
These symptoms were indicative of an organization in significant stress; implementing an EMR might represent one of the greatest changes in care delivery and departmental operations in our hospitals' history. As with any great change, though everyone understood the concept, few had experienced the reality (of an EMR in another clinical setting). Given the immaturity of these solutions and the vast differences between vendor products, even those with experience might not have a vivid picture about what was to come. Moreover, incremental implementation plans had the additional burden of communicating in what sequence key capabilities would be available. There was no single date that everyone came into work and we were fully electronic; instead there were 10 dates where individual functions became electronic, and by the end, we were fully electronic.
To address these growing stress points, we'd returned to the basics of IT management and project management. We'd found the need not just to implement these project management practices, but put these practices front and center with our IT staff as well as hospital staff so that everyone understood we were working together on a project. A project has milestones, and to achieve these milestones we must commit resources to certain tasks to achieve certain pre-defined goals (scope); many of these tasks will be related (dependencies) and to complete tasks we will often need to overcome obstacles (risks) in a timely manner.
We focused our efforts on a few key project management practices that we believed would have the greatest impact on our campus. These practices are detailed below:
1. Define the critical success criteria for each module
It is crucial that the key critical success criteria be defined for each individual module of an EMR (results, anesthesia, orders, nursing documentation, etc.). Most organizations define goals for each of these areas, but stop there. Goals must be translated into specific application functionalities that lead to practical operational capabilities. These operational capabilities are the critical success criteria at UTSW. In fact, we defined the top 15 capabilities that each module must deliver. These capabilities help us manage scope and help us prioritize work on a daily basis.
2. Organizing the work on a weekly and monthly basis
Organizations, as a whole, can manage change efforts at a monthly level. The project plan should be developed with a monthly milestone discipline that can be communicated and managed with hospital leadership. Once the clinical leadership is engaged with the key monthly milestones, they can assist in work prioritization, and ensure key deliverables are completed. The project team, however, must have weekly milestones to complete project tasks, so that work can be adjusted on a weekly basis to ensure monthly milestones are met.
3. Make the calendar public
It is crucial that all levels of hospital leadership have access to the project timeline with monthly milestone details. This will allow the leadership to better understand the implementation, and allow them to better plan their other operational decisions and activities. On the project team, make the project plan and weekly work assignments of all team members available to the entire team. This will promote greater visibility and critical thinking on the project team about the work.
4. Standard status reporting for the organization
A well-designed status report can help move a project forward more rapidly than any other project activity. When hospital and IT leadership are empowered with specific, practical knowledge of what needs to be done, significant organizational obstacles can be overcome. The key to the status report is to tailor it for the appropriate audiences with the appropriate level of detail to help the reader become informed and take action. For the hospital leadership, this should be tied to the monthly milestones and should follow a twice-a- month-frequency (one half-way checkpoint as well as monthly summary). Within the IT realm, status reports should be weekly.
5. Resource conflict management
With concurrent components of the EMR in progress, one of the greatest challenges for project managers is managing resource conflicts and IT environment issues. It is crucial that the project team set up a tracking mechanism for what resources are required over the upcoming weeks and months to forecast potential resource conflicts. Increasingly, there are resource conflicts for hospital subject matter experts in the pharmacy or performance improvement. Similarly, IT must create an air-traffic control plan for the application environments for development, testing and training to ensure that staff does not step on one another's toes during the implementation process.
Many of these project management practices are relatively obvious. The discipline to follow through on the obvious may be the single greatest success criteria in an EMR implementation.
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