Synopsis
This white paper describes an effective methodology that integrates standards and best practices from project management, information technology management, and change management for a streamlined transition to digital medicine.
This article includes the Knowledge Areas for each management discipline, organized by the core project management Process Groups, Initiating, Planning, Executing, Monitoring and Controlling, and Closing. Examples from healthcare information technology projects illustrate how this integrated approach can lead to improved healthcare delivery.
The Challenge
The Health Information Technology for Economic and Clinical Health (HITECH) Act (U. s. Department of Health and Human Services, 2011) seeks to improve American healthcare delivery and patient care through an unprecedented investment in Health Information Technology (HIT).
Only 4% of physicians report having extensive, fully functional Electronic Health Records (EHR) systems due, in part, to:
- Resistance from physicians
- Loss of productivity
- Uncertainty about return on investment
- Inappropriate patient information disclosure (DesRoches, Campbell, Donelan, Ferris, Jha, Kaushal, et al., 2008, pp 50-60)
The United States plans to spend over US$18 billion on HIT in the next five years (Millard, 2010, p 2), yet:
- We consume 15% of our GDP in healthcare and receive what many would call second-class care (Goldman, McGlynn, 2005, p 3)
- A patient walking into a clinic or hospital has only a 55% chance of getting the right medical advice (Goldman, McGlynn, 2003, p 3)
Without improving HIT project success rates:
- The value of HIT diminishes
- Future HIT investment is at risk
- Ever-increasing demand on healthcare services will result in a greater healthcare crisis
The Solution
Unless we change how we perform HIT project management, we will not improve healthcare adequately. This requires a fundamental shift in how organizations manage HIT projects, as follows:
- Relying on the project management, IT management, and change management disciplines individually does not ensure project success
- Integrating all three increases the likelihood of project success
Exhibit 1 illustrates applying Project Management Institute's A Guide to the Project Management Body of Knowledge (PMBOK® Guide) (PMI, 2008) Process Group framework across the life cycle of a project to integrate the project management, IT management, and change management disciplines.
Exhibit 1 – PMBOK Process Groups
Exhibit 2 illustrates supplementing the existing PMBOK® Guide project management Knowledge Areas with:
- IT knowledge areas from the Institute of Electrical and Electronic Engineers’ A Guide to the Software Engineering Body of Knowledge (SWEBOK) (IEEE, 2004)
- Change management knowledge areas from organizational behavior and organizational development well-developed theories and practices
Exhibit 2 – Knowledge Areas
Exhibit 3 illustrates integrating these three disciplines into a single methodology
Exhibit 3 – Integrated Project Management
“Project management was an absolute critical aspect of our…implementation. Unless you have sufficient and tuned in project management for a large-scale clinical systems initiative, it's bound to fail. That's not just the management and technical components, obviously that's important and necessary. Change management, for example, includes user training, understanding user existing workflow, and how those workflows might change with the implementation. I think those aspects are equally if not more important than the project and technical aspects of the implementation”. (Coplan and Masuda, 2011, p 7)
Empowering HIT personnel with IPM skills helps improve patient care.
Exhibit 4 – IPM Shifts the Focus to Meeting Patient Needs
Changes in workflow, defined using IPM, engage the caregiver and patient in a dialogue, “strengthening the therapeutic alliance between the physician and patient and improving patient satisfaction” (O’Connor, Wennberg, France, et al., 2007, p 724).
Computerized Physician Order Entry (CPOE) [and Clinical Decision Support (CDS)] has the potential to significantly reduce hospital-wide mortality rates (Longhurst, Parast, Sandborg, et al., 2010, pp e1-e8).
Exhibit 5 – IPM Improves Patient Outcomes
Additional Resources
Project Management for Healthcare Information Technology (HIT) is the first book specifically written about this topic. Throughout the book, quotes from the following healthcare leaders around the country identify how IPM enabled them to reach their organization's HIT project objectives:
- Florence Chang, CIO Multicare, Tacoma, Washington, USA
- Robert Greenless, PhD, former CIO, Rancho Los Amigos National Rehabilitation Center (RLANRC), Los Angeles, California, USA
- Ernie Hood, CIO, Group Health Cooperative (GHC), Seattle, Washington, USA
- Beatha Johnson, Director, Clinical Information Systems, Virginia Mason Medical Center (VMMC), Seattle Washington, USA
- Daniel Nigrin, MD, MS, CIO, Children's Hospital Boston, Boston, Massachusetts, USA
- Michael H. Zaroukian, MD, PhD, FACP, FHIMSS CMIO, Michigan State University (MSU), Lansing, Michigan, USA
Interactive Integrated Project Management Model
An interactive version of our integrated model is available at Coplan and Company. (http://www.coplan.com/our-tools/integrated-model/initiating)
