HIT System Lifecycle:

Proven Project Management

M th d Workshop
Methods W k h

J d M
Judy Murphy
h , RN, FACMI, FHIMSS
Vice President, Information Services,
Aurora Health Care, Milwaukee, WI
judy murphy@aurora org
judy.murphy@aurora.org

Cindy Gadd, PhD, MBA, MS

Associate Professor & Director of Educational Programs,
Dept of Biomedical Informatics, Vanderbilt University
cindy.gadd@vanderbilt.edu
Agenda
Tuesday, May 25, 2010
10:00-10:10am Introductions & Review Agenda
g
10:1010:50am PART 1: Systems Lifecycle
10:50-11:00am Exercise Set-Up
11:0011:30am p
Complete Exercise & Take Break
11:30-11:40am Exercise Report-Out
11:40-12:15pm PART 2: Project Management

Wednesday,
Wednesday May 26,
26 2010
1:30-1:40pm Introductions & Review Agenda
1:402:20pm PART 1: Systems Lifecycle
2 20 2 30
2:20-2:30pm E
Exercise
i S Set-Up
t U
2:303:00pm Complete Exercise & Take Break
3:00-3:10am Exercise Report-Out
3:10-3:45pm
3 10 3 45 PART 2
2: PProject
j tM Managementt
2
PART 1: System Life Cycle

We will cover
9 What is the Systems Life Cycle
9 What is a Project
9 What is Project Management
9 10 Reasons Projects Fail

3
 As people learn from past mistakes in completing IT
projects, a model has been developed and refined over
the years to try and maximize the chances of a successful
project.
This method / model is called the SYSTEMS LIFE CYCLE,
and outlines the steps in an IT project.
It consists
i t off a series
i off stages
t that
th t take
t k a project
j t from
f its
it
very first stages to the final outcome of a fully working,
fully integrated system.
Th
The term
t 'lif
'life cycle'
l ' is
i used
d because
b the
th process never
really ends. Systems are created, they become mature,
they grow old and are replaced by new ones. It is a cycle.

4
5
Why is Systems Lifecycle needed?
IT change is particularly risky!
Consider the sobering results obtained from a survey of
over 14,000 organizations (OASIG study(1)):
80-90% of systems fail to meet performance goals
80% of systems
y are late and over budget
g
40% of systems fail or are abandoned
Less than 40% of implementations fully address training and
skills requirements
Less than 25% properly integrate business and technology
objectives
Just 10-20% of businesses meet all their success criteria.
The Standish Group research(2) shows:
31.1% of projects are canceled before they get completed
52.7% of projects cost over 189% of their original estimates
Only 16.2% of projects are completed on time & on budget
(1) http://www.it-cortex.com/Stat_Failure_Rate.htm (2) http://www.projectsmart.co.uk/docs/chaos-report.pdf

6
There are many things that can and do go wrong
when an organization is planning to develop/install a
new HIT system.
t H
Here iis a humorous
h look
l k att a few:
f

http://www.geekzone.co.nz/juha/1637
What could be done better?

What could reduce the

chances of failure?

Pay attention to the Systems Lifecycle

Use good Project

oject Management
a age e t

8
 Systems Lifecycle

Parallels with the Problem-Solving Process

Organization Analysis Development Testing Training Implement Post

& Design (Build) Conversion
Support

Assess Diagnosis Plan Intervene Evaluate

9
 Systems Lifecycle

Organization

Project Charter
Scope
Organization Chart
Project
Project Team
Budget
Identify Improvement
Opportunities
Benefit
Benefit Realization
Baseline Measures

10
 Systems Lifecycle

Organization Analysis
& Design

Process
P Fl
Flow A
Analysis
l i & Redesign
R d i
Hardware
Detailed System design:
Applications
Features/functions
F t /f ti
Database/Vocabularies
Security
Reports
Interfaces
I t f

11
Analysis and Design

Documentation of Current State

M
Meett with
ith stakeholders
t k h ld
Who will be effected
Gather what y you are doingg today
y
Current workflow process
Current examples, tools, printouts
Current problems/challenges
Identify data you want coded for automation
Determine if changes will be made
Determine
D t i a process for
f change
h
Determine a process of signing off change

12
Analysis and Design

Future State Design

Workflow Re-Engineering/Process Re-Design
Identify Process Tasks
Streamlined by automation
Enhanced by operational change
Eliminated
Learn
L the
th functionality
f ti lit off your new system
t to
t
design and make decisions
Gap Analysis
Current to Future
Reality vs. Blue Sky; 1 or 2 step process

13
 AMCMC FUTURE STATE
INPATIENT RECORD PROCESSING

Sample
START AFTER
PATIENT IS
DISCHARGED

Visio OBTAIN DISCHARGE

REPORT FROM
INCOMPLETE AREA
DISCHARGE
REPORT

Workflow OBTAIN INPATIENT

RECORDS FROM CLINICAL

Diagram
AREAS THE MORNING
Volumes will
AFTER DISCHARGE
normally be
created when
patient is
VERIFY ALL CHARTS HAVE admitted
BEEN RETREIVED

himCreateVolume.exe

CREATE
VOLUME
New
no-new Profile
Existing chart Print bar chart
Existing ? code
chart

yes
himCreateVolume.exe

UP DATE Profile
UPDATE THE CHART
CHART
LOCATION
LOCATION

himUpdateChartLocation.exe

Visit
records ASSEMBLE THE CHART
ADD VISIT RECORDS TO
THE CHART
himCreateVolume exe
himCreateVolume.exe
CREATE New
Patient IS THE VOLUME Profile chart
YES
chart FOLDER
FULL? Print bar
code
NO

PLACE CHART ON PRONGS

PAGE
2
 PATIENT IDENTIFIER DATA FLOW
Updates Only SUNQUEST Open Engine will prefix the patient ID
with
i h the
h client
li code
d (2600) to kkeep
PATIENT ID's HPC patient unique on SunQuest.
---------------------- Likewise, on outbound transactions,
Open Engine will strip off the client
"HM" 11111111 code prefix.
(ROBERT SMITH)
Outstanding decision: Should we
prefix with the entire client code or
"HM" 260011111111 just use the org code (i.e., 26)?
(JANET JONES) ORD ID's
SMS _________
REGISTRATION
PAT ID + HIS ORD NUM +

Sample
000011111111 SUNQ ORD CODE
NOTE: NAME: JANET JONES
The manual chatr# is
not always known at
the time of CHART # = 00185731
registration. Also, the

Data
clinic location is not Updates Only CHARTSCRIPT
identified at the time CASE # = 00666666
of registration. PATIENT ID's
--------------------- Store CHART#
PT KEY=PAT SYS ID "HMH" 11111111 12345678 in UDF?

Flow
(MANUAL CHART# - Data Field) (ROBERT SMITH)
FIN KEY=CASE# "HPC" 11111111 115808
NOTE:
(JANET JONES) Order
SMS [Clinic locn => Locn code] DOC ID's

Diagram
The encoutner# is Status
generated at the time SCHEDULING __________
of the scheduled
appointment. The Orders
clinic location is 000011111111 PAT ID + DOC
identified at this time NAME: JANET JONES (Need Order # for
too. A "Reg" Results
transaction is Radiology)
genterated for all CHART # = 00185731
feeds, then a
schedule transaction ENCOUNTER# = 115808
to HNA. Also, the
Updates Only HNA Orders Order
manual chart# is not
always known at the PATIENT ID's Status
time of the scheduled ---------------------
FIN KEY=ENCOUTNER#

Lab Charges
appointment.
(3100) 11111111 12345678
(ROBERT SMITH)

H
(2600) 11111111 115808

N
A
(JANET JONES)

O
ADZ

SunQuest L
ORD ID'sID s

rd
[Cli i llocn =>
[Clinic > ffacility
ilit code]
d ]

er
----------------

s
an
d
PAT ID + HNA ORD NUM Results

C
"31" 11111111

ha
rg
NAME: ROBERT SMITH

es
CASE# = 12345678
OCF ChartScript Dictating
SMS
BILLING
Radiologist
"HMH"
HMH 11111111 PROCESS
PT KEY=HOSP ORG+MRU# (ROBERT SMITH)
FIN KEY=CASE#
"HPC" 11111111
(JANET JONES) IDENTIFIERS NEEDED:
1) MRU# or PAT SYS ID...
2) CASE# or ENCOUNTER #...
3) ORDER #, If applicable...
 Systems Lifecycle

Organization Analysis Development

& Design (Build)

Construct
C t t Databases
D t b
& Data Dictionaries
Configure Applications
Build Security
Write
W it Reports
R t
Infrastructure
Desktop/Mobile devices
Printers
Network
N t k
Redundancy/Disaster recovery
Interfaces
Write Policy/Procedures

16
 Systems Lifecycle

Organization Analysis Development Testing

& Design (Build)

Conduct Testing
- Unit
- System
- Integration
- Stress
- Volume

17
 Systems Lifecycle

Organization Analysis Development Testing Training

& Design (Build)

Complete
Training
Materials
Conduct Train
the Trainers
Conduct
End User
Training

18
 Systems Lifecycle

Organization Analysis Development Testing Training Implement

& Design (Build)

Operational
i l
Readiness

Go/No-Go
Decision
i i

Go-Live

19
 Systems Lifecycle

Organization Analysis & Development Testing Training Implement Post

Design (Build) Conversion
Support

20
What is a Project?

A project is a multi-task,
one-time job that has
d fi it starting
definite t ti and d
ending points, a well-
defined scope of work to
be done, a budget, and a
temporary
p y team.

http://en wikipedia org/wiki/Project management

http://en.wikipedia.org/wiki/Project_management

21
What is a Project?

The Project Management Institute (PMI)

d fi
defines a project
j t as ffollows:
ll

A project is a temporary endeavor undertaken to

create a unique product or service.
Temporary means that every project has a
d fi i b
definite beginning
i i and dad definite
fi i end.
d
Unique means that the product or service is
different in some distinguishing way from all
other products or services.

http://www.pmi.org/Pages/default.aspx

22
What is a Project?

A project is a
p
problem
scheduled for
solution.
solution
Dr. J. M. Juran

http://www.juran.com/HomeLeftNav/juran_mgt_system.aspx

23
Project Management Defined

Project management is
facilitation of the
planning, scheduling,
and controlling of all
work that must be done
to meet project
objectives.

24
What Is Project Management?

Project management is the

application of knowledge, skills, tools
and techniques
q to p
project
j activities
to meet project requirements.

Project management a systematic process

for implementing systems on time, within
budget,
g , and in line with customer
expectations of quality.

2004. A guide to Project Management Body of Knowledge (PMBOK), 3rdd Ed.

25
 Project Management across the
Systems Lifecycle

Organization Analysis Development Testing Training Implement Post

& Design (Build) Conversion
Support

Start ...Project Management.

Plan (Project Organization & Work Planning)

26
OTHER RESOURCES:
Top 10 Project Management Challenges by P.W. Ford
htt //
http://projectmanagementcourse.com/project-challenges.html
j t t / j t h ll ht l

Project Mangement Imperatives: Ten Keys to Success by Jerry Manas

http://www.pmthink.com/2007/01/project-management-imperatives-ten.htm

27
Exercise Set-Up

Strategic
g Analysis
y
SWOT Analysis
Stakeholder Analysis
y

28
Initiating: SWOT Analysis
((StrengthsWeaknesses-Opportunities-Threats)
g pp )

SWOT Analysis: Strategic planning is an

important component of project initiation and
planning.
Focuses team members on project requirements and
facilitates identification of factors that may impact
achievement of project deliverables.
Assists with identifying potential Strengths and
Weaknesses of your team relative to a project and
the ppotential Opportunities
pp and Threats inherent in
the project.

29
*Template available in workshop handouts
Initiating: SWOT Analysis
(
(StrengthsWeaknesses-Opportunities-Threats)
g pp )

30
Initiating: Stakeholder Analysis
Documents important (often sensitive)
information about each stakeholder:
Stakeholders names
Their roles on the project
Unique facts about each stakeholder
Their level of influence on and interest in the project
Suggestions for managing relationships with each
stakeholder what do you need form them and what
do they
y need from you
y
Identify potential sources and causes of resistance
and strategies for overcoming

31
Initiating: Stakeholder Analysis

32
Plan to influence Stakeholders

33
Agenda
Tuesday, May 25, 2010
10:00-10:10am Introductions & Review Agenda
g
10:1010:50am PART 1: Systems Lifecycle
10:50-11:00am Exercise Set-Up
11:0011:30am p
Complete Exercise & Take Break
11:30-11:40am Exercise Report-Out
11:40-12:15pm PART 2: Project Management

Wednesday,
Wednesday May 26,
26 2010
1:30-1:40pm Introductions & Review Agenda
1:402:20pm PART 1: Systems Lifecycle
2 20 2 30
2:20-2:30pm E
Exercise
i S Set-Up
t U
2:303:00pm Complete Exercise & Take Break
3:00-3:10am Exercise Report-Out
3:10-3:45pm
3 10 3 45 PART 2
2: PProject
j tM Managementt
34
PART 2: Project Management

We will cover
9 Five Process Groups and the IPECC Flow
1. Initiating
2
2. Planning
3. Executing
4. Monitoring & Controlling
5. Closing
9 Knowledge Areas in each Process Group
9 The Triple
Triple Constraint
Constraint

35
Project Management Methodology

Provides a
systematic TIME

means to gain
control over
cost, quality, PROJECT COST
QUALITY
risk, scope, & MANAGEMENT

time
(e.g. variables
that determine RISK
SCOPE
project
success)

36
Project Management:
5 Process Groups

1. Initiating
g
2. Planning
3
3. Executing
4. Monitoring and Controlling
5
5. Cl i
Closing

37
The IPECC Flow

Initiating Planning Executing

Monitoring &
Controlling

Closure

Source: Partners HealthCare PMO 38

Level of Activity and Overlap of
Process Groups Over Time

Source: Schwalbe, K. (2006). Information Technology Project Management, Fourth Edition, pg. 73.

39
40
 Relationship of Process Groups
Process groups can be
mapped to the Plan-
Do-Check-Act Cycle.
Cycle
Each process group
marked by:
Inputs, tools and
techniques, outputs
(deliverables).
Individual process
groups linked by
inputs/outputs.
Outputs from each
process group
become inputs to
next process group.
Often iterated prior to
Project Management Process Groups Mapped to the Plan-Do-Check- project completion.
completion
Act Cycle (PMBOK, 2004; p. 40)

41
Process Group Triangle

When
l
large/complex
/ l
projects are
separated into
phases the
phases,
process
groups will be
repeated for
each phase

Project Management Process Group Triangle (PMBOK, 2004; p. 69)

42
 Knowledge Areas for each Process Group
Knowledge Area Project Management Process Groups
Initiating Planning Executing Monitoring & Closing
Controlling
Project Integration Management X X X X X
Project Scope Management X X
Project Time Management X X
Project Cost Management X X
Project
j Q
Quality
y Management
g X X X
Project Human Resource X X X
Management
Project Communications X X X
Management
Project Risk Management X X
Project Procurement Management X X X X
Adapted from: Schwalbe, K. (2006). Information Technology Project Management, 4th Edition, pps. 76-77

43
The IPECC Flow

Initiating Planning Executing

Monitoring &
Controlling

Closure

Source: Partners HealthCare PMO

44
Initiating Purpose

The purpose of the project initiation process

is to identify
identif the project
p oject need,
need stakeholders,
stakeholde s
and main goals of the project.
Identify the problem this project solves
Understand the business case & ROI
Identify the project players
Create a shared vision for the project
deliverables
C
Craft
ft a project
j t mission
i i th t iis congruentt with
that ith
the vision of the organization

45
Initiating Tools & Techniques
Business Case
SWOT Analysis
(StrengthsWeaknesses-Opportunities-Threats)
Stakeholder Analysis
Skill Inventory
I t
Project Charter
Roles & Responsibilities Matrix / RACI Chart
(Responsible-Accountable-Consulted-Informed)
Value Risk Assessment
W i ht d Decision
Weighted D i i Matrix
M t i
Project Portal
Project Initiation Checklist
46
Initiating: Project Charter

Approject
j charter is a document that
formally recognizes the existence of a
project and provides direction on the
projects
project s objectives and management.
management
Key project stakeholders should sign a
project charter to acknowledge agreement
on the goals & intent of the project.
Defines the overall approach to the project,
project
the deliverables and project success

47
the Project Charter

Facilitates communication among stakeholders

Defines approved purpose,
purpose scope,
scope objectives,
objectives cost and
schedule baselines
Documents agreement between groups/stakeholders
Documents assumptions
Provides baseline for scope and expectation management
Shows how project will be organized
Lists team members
Defines roles/responsibilities
Describes
D ib purpose & mission
i i
Identifies project goals
Describes deliverables ((tangible
g p
phase outputs)
p )

48
Project Charter example

49
Initiating: RACI Chart

50
Initiating: Value Risk Assessment

51
Initiating: Weighted Decision Matrix

52
The IPECC Flow

Initiation Planning Executing

Monitoring &
Controlling

Closure

Source: Partners HealthCare PMO

53
A
common
argument
for not
planning
is, We
dont have
time to The more
plan. critical the
deadline,,
the more
necessary
the plan.
plan
54
Planning Purpose, Tools & Techniques

The purpose of the project planning

process is to guide execution of the
project.

Tools & Techniques

Scope Statement including what
whats
s in and
whats out of scope
WBS: Work Breakdown Structure
Gantt Chart

55
Simply put, the PLANNING phase defines

56
Planning: Scope Statement

Developed from:
Voice of the
customer
Project charter
Stakeholder
analysis
SWOTO aanalysis
ay
(strengths,
weaknesses,
opportunities,
threats)

57
Planning: Work Breakdown Structure
(Network Diagram format)

WBS: A deliverable-oriented grouping of project elements and

tasks that organizes and defines the total scope of the project.
(Milosevic, 2003)

58
Planning: Work Breakdown Structure
(Gantt Chart format)

59
60
61
62
63
The IPECC Flow

Initiation Planning Executing

Monitoring &
Controlling

Closure

Source: Partners HealthCare PMO

64
65
Executing Purpose

The purpose of the executing process is to complete

the
h work k in the
h project plan,
l meet project
requirements on time, within budget and in a way
that is satisfying to the customer

Commonly involves:
Developing specifications
Conducting programming
Conducting testing
Int od ing ne
Introducing new ha
hardware/software/procedures
d a e/soft a e/p o ed es

66
Executing Tools & Techniques

Project Meeting
agendas and minutes
Request for Proposal
Template
Updated Gantt chart
Planned vs. Actual
Time
Ti Reporting
R ti ttooll
Risk identification and
mitigation plan
Issue log
Progress/Status reports

67
Executing: Time Reporting Tools

68
Executing: Issue Log

69
The IPECC Flow

Initiation Planning Executing

Monitoring &
Controlling

Closure

Source: Partners HealthCare PMO

70
Monitoring & Controlling Purpose

The purpose of the monitoring &

cont olling processes
controlling p ocesses is to observe
obse e pproject
oject
execution so the potential problems can be
identified
de ed in a timely
e y manner
a e and
a d
corrective action can be taken when
necessary to control execution of the
project
j t (PMI, 2004).
Performed throughout life of project (within
process g
p groupp and across p
project)
j )
Provides feedback between project phases

71
Monitoring & Controlling Definitions
Monitoring: keep track of project processes
associated with initiating,
initiating planning,
planning executing and
closing a project.
Project performance (actual) vs. project plan (projected)
Risks identified, tracked, response plan in place
Status reporting, progress measurement and reporting

Controlling: Corrective or preventive actions

taken to direct project performance.
Determining when change has occurred
Managing and approving change.
May necessitate revisiting the project plan and making
updates.

72
In words, Cost
Cost is a function of
Performance, Time, and Scope.

73
Project Management:
The Triple Constraint
Framework for
evaluating
l ti
the project impact
when changes
occur in time
time, cost
or scope.
Quality is at
center.
center
Changes in one
point will affect at
least one other
point and is likely
to affect quality.

74
Monitoring & Controlling Tools

Project management
methodology
h d l
Project management
system
Time reporting tool
Progress reports
Expert judgment

75
Monitoring & Controlling:
Progress Reports
How is my project
doing overall?
Are my project on
schedule?
Are myy time
estimates
accurate?
Are my resources
properly utilized?
Are my cost
estimates
accurate?

76
Monitoring & Controlling:
2001
ID Task Baseline Actuals E-A-C Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Admin 3,042 hr 772 hrs 3,086 hr
6 Training 1,119 hr 245 hrs 1,114.5 hr
10 Support 780 hrs 139.5 hr 755 hrs
14 WAMH 3,689.5 hr 1,316 hr 4,152.42 h
18 Benefits Measurement 24 hrs 2 hrs 17.97 hr
22 Planning Steps 22 hrs 22 hrs 22 hrs
27 Current State 281 hrs 290.5 hr 290.5 hr
30 Complete Interviews 63 hrs 65 hrs 65 hrs Red
R d=O Original
i i l Baseline
B li
70 Perform Process Observat 59 hrs 59 hrs 59 hrs Black = Current Schedule
110 Complete Visio's 135 hrs 142.5 hr 142.5 hr
150 Future State 803.5 hr 468 hrs 761.6 hr
156 Visio WorkFlow Design 54 hrs 70.5 hr 70.5 hr
196 App Build Design 657 hrs 350.5 hr 558.73 hr
197 Radnet 143 hrs 139 hrs 194.1 hr
200 Superuser Training 73 hrs 36.5 hr 54 hrs
212 Firstnet 79 hrs 30.5 hr 84.9 hr
235 Carenet/Orders 410 hrs 181 hrs 279.73 hr
254 Obtain Visio Signoffs 40.5 hr 23.5 hr 28.5 hr
294 Cert Build WAMH and SSMC 241 hrs 150.5 hr 314 hrs
295 Radnet 103 hrs 108 hrs 126.5 hr
345 Firstnet 28 hrs 9.5 hrs 31.5 hr
356 Carenet/Orders 110 hrs 33 hrs 156 hrs
387 Testing 462.42 hr 79.5 hr 496.03 hr
392 Functional 175.42 hr 51.5 hr 191.33 hr
397 Integration 160 hrs 0 hrs 160 hrs 77
402 Problem Resolution 32 hrs 3 hrs 41.2 hr
407 Prod Build WAMH and SSMC 532.5 hr 5 hrs 547.5 hr
The IPECC Flow

Initiation Planning Executing

Monitoring &
Controlling

Closure

Source: Partners HealthCare PMO

78
Closing Purpose

Finalize all project activities to

f
formally
ll close
l th
the project
j t
Finalize all activities and transfer the
remaining work to the appropriate people
Main outputs include:
Administrative
d st at e closure
c osu e procedures
p ocedu es
Contract closure procedures
Final products, services, or results
Measurements for benefit realization and
return on investment

Celebration!

79
Closing Tools & Techniques
Project Closure Meeting
Post Implementation
p Survey
y
Product Effectiveness
Management of the Triple Constraints (Scope, Budget, Schedule)
Risk Management
C
Communications
i ti M
Managementt
Acceptance Management
Organizational Change Management
g
Issue Management
Performance of the Project Team
Lessons Learned Meeting
What was done well?
What was done poorly?
Where improvement is needed in future projects?
Project
j Closeout Checklist

80
PMI (Project Management Institute)

81
PMP (Project Management Professional Certification)

82
 Thanks!

From Judy & Cindy