Project Management Institute

Doctor's orders

Copenhagen, Denmark

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INNOVATIVE RESEARCH AND DEVELOPMENT

img A doctor immediately got the idea and took over and said, “We can do this and this and this!”

—Peter Lundkvist, Nhumi Technologies GmbH, Zürich, Switzerland

Copenhagen, Denmark

Case by Case: Innovation in Action

The symptoms weren't too hard to spot. Left to contend with nearly 11,000 inpatient beds and more than 65,000 outpatient visits per year, the doctors at Thy-Mors Hospital in Copenhagen, Denmark were suffering from information overload. Operating on a tight schedule, they have to mentally download and process entire medical histories from files scattered across systems, take in what patients say, and then make decisions that can literally mean life or death.

Looking for a way to incorporate all that stray information, the hospital kicked off a pilot project in December 2008 to test new medical imaging software developed by IT giant IBM at its research lab in Zürich, Switzerland. Heralded as “a Google Earth for the human body,” the ground-breaking technology lets doctors click on any part of a 3-D avatar of the human body to trigger a search of medical records.

The project was dubbed “intelligent electronic patient records,” but it's really a complete encapsulation of each patient's current chart and medical history in a transparent body model that can be rotated, magnified and written on.

“I can see much more information than just what the patient tells me is bothering him or her that day— information for which I would otherwise have to spend considerable time searching through our current records system,” says Dr. Hardy Christoffersen, head of the hospital's surgical outpatient clinic.

The test project also showed how the technology can help doctors spot data that may be indirectly related to current health problems but still relevant to the treatment. Search results for “heart trouble,” for example, wouldn't simply include those two words. It would also cover terms such as “right ventricle” or “radiating pain in left arm”—and show them off on a 3-D avatar.

But this wasn't simply a matter of coming up with really cool, cutting-edge technology—the project management process turned out to be just as innovative.

“From the technical side, this is a first-of-a-kind project,” says Andre Elisseeff, the project manager at IBM Research at the time of implementation and now CEO of Nhumi Technologies GmbH, a spin-off launched in January to market the system.

“It's as much an implementation of a project as it is a research and development project. You deploy a new technology and as soon as you put it in place, you need to revise some components and sometimes change the underlying methodologies,” he explains. “That was factored into the project management. The timeline was extended to accommodate for such changes.”

There was the matter of those doctors, for example.

Pre-existing Conditions

Most Danish hospitals have electronic records systems in place. Although used widely across the country, the technology is still evolving, creating a mishmash of systems—and a breeding ground for errors.

Yet despite any grumblings about the current system, the team knew medical professionals might be resistant to changes in procedure—especially those proffered from outside of the medical community. To gain some insight into the stakeholders, IBM conducted a January 2007 survey on IT usage among European healthcare organizations. The research confirmed that the big challenge was information overload, but the question remained: How does a project manager secure buy-in from a skeptical user base whose time demands are already stretched to the limit? Turns out it was as easy as saying “ahh.”

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IMAGES COURTESY OF IBM RESEARCH–ZURICH

65,000 The number of outpatient visits that doctors at Thy-Mors Hospital contend with every year

“Oh, it was very easy to sell it,” says Peter Lundkvist, healthcare innovation manager at IBM and now director of sales at Nhumi Technologies .

The company held workshops aimed at explaining the technology and discovered the doctors were quick converts.

“A doctor immediately got the idea and took over and said, ‘We can do this and this and this!’” Mr. Lundkvist says.

Doctors in sessions wasted no time communicating wish lists of functionality. From there, achieving project success was a simple matter of following doctors’ orders.

“We had workshops with doctors where they told us what we should do and what we should change, where they were developing the tool together with us,” says Mr. Lundkvist.

Once the project reached the evaluation stage, the team brought in a new round of doctors from for a fresh evaluation and a real-world trial—without any formal training. The philosophy was that doctors don't have the time to spend learning how to use software.

It worked.

“They got it,” Mr. Lundkvist says. “They didn't trust [the technology] before we gave it to them, then they started using it.”

Clean Bill of Health

New technology developed? Check. Skeptical stakeholders convinced? Check. Even the selection of a suitable testing site was uncomplicated.

“We simply started our car, drove to the first [regional hospital office] and never got any further,” says Mr. Lundkvist.

He punctuates his story with the uncontrolled laughter of a project manager who can't quite believe it was so easy.

When the IBM team arrived in March 2008 to launch the pilot project, the staff at Thy-Mors Hospital was ready and willing to test out the new technology.

“At that time, they didn't know if it was going to succeed or not, but they wanted some kind of experience with it,” Mr. Lundkvist says. “They had used an electronic recordkeeping system for 10 years so they had a large amount of data, which was the perfect place for us to be.”

The hospital made for an ideal “patient.”

“Along the way, many things changed and we found new ideas and new ways to use the tools, but the first idea was to improve usability of IT in hospitals and subsequently improve doctor-patient communications with the help of computers,” says Mr. Elisseeff.

The prognosis was good—until the nurses went on strike.

“That was entirely unexpected,” says Mr. Elisseeff. “On the technical side, the pressure that this strike put on us was big. You set a project, resources are allocated for a certain amount of time, and you can't put your project team on hold and tell your colleagues that you can't pay them for three months and that they'll have to wait another three months until we get feedback from users.”

Instead of sitting it out in the waiting room, the project team used the downtime to program potential components.

“The nurses went on strike just when we were supposed to do some of the first tests. The project had already started and we already had several discussions with our clinical partner. So we knew what options we needed to investigate,” says Mr. Elisseeff. “On the other hand, we did not know which one was right and therefore spent this time developing several components in parallel. When the project resumed, we put aside only a fraction of these components. Most of what we did when the nurses were on strike could be re-used and saved us some time later on.”

Once the system was in place, the pilot project earned high marks from the staff. The hospital's director Kurt Nielsen called it “an important step toward the future of e-health.”

And even though the project probably isn't a miracle cure for healthcare administrative woes, it did show what a little IT innovation can do. In the pilot project, for example, doctors were able to cut the time they spent on outpatient treatment by as much as two-thirds.

“I think we had a charmed project,” says Mr. Lundkvist, “and I think it's because doctors can see the need for something like this.” —Chauncey Hollingsworth

This material has been reproduced with the permission of the copyright owner. Unauthorized reproduction of this material is strictly prohibited. For permission to reproduce this material, please contact PMI.

CASE BY CASE OCTOBER 2009 WWW.PMI.ORG

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