Implementation of Angel-Eye Milk Tracker System

Eric Wyatt

Hahn School of Nursing and Health Science, University of San Diego

Dr. Barbara Berkovich

HCI 542: System Analysis and Design

05/14/2022

University of San Diego © 2016. All Rights Reserved.

Document Control

Document Information

Information

Document Id 009295163

Document Owner Eric Wyatt

Project Kick-off date 02/01/2022

Last Saved Date 05/14/2022

File Name HCIN542_PMP_EricWyatt_V5

Document History

Version Issue Date Changes

1.0 2/28/2022 Section 1.1 – 1.2, Appendix A

2.0 3/1/2022 Section 1.3 – 2.1, Appendix B

3.0 4/18/2022 Section 3 – 4, Appendix B, C and D

4.0 5/2/2022 Section 5 – Appendix E

5.0 5/14/2022 Section 6 - Appendix F

Document Approvals

Role Name Signature © Date

Dr. Barbara Berkovich

Project Sponsor

Eric Wyatt
Project Manager

1
Table of Contents

1 Planning Basis 1
1.1 Project Charter 1
1.2 Scope 1
1.3 Milestones 1
1.4 Phases 2
1.5 Activities 3
1.6 Tasks 3
1.7 Effort 5
1.8 Resources 6
2 Project Plan 7
2.1 Schedule(Gantt chart) 7
2.2 Dependencies 8
2.3 Assumptions 8
2.4 Constraints 8
3 Workflow Analysis 8
4 Stakeholder Analysis 9
5 Risk Reduction 9
6 Evaluation 11
Appendix A. Project Charter 12
Appendix B. Work Breakdown Structure 18
Appendix C. Workflow Analysis 19
Appendix D. Stakeholder Analysis 20
Appendix E. Failure Mode Effects Analysis 24
Appendix F. Post Implementation Evaluation 26

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1 Planning Basis

1.1 Project Charter

Implement breastmilk management application throughout the Mary Church Women’s Hospital.
This application will replace the currently utilized application which will require modification to
current workflows across the nursing and lactation departments. This project aims to promote
accurate breastmilk administration to patients and to assist in proper breastmilk inventory
management.

Click here for complete Project Charter

1.2 Scope

The Neonatal Intensive Care Unit (NICU) in the Mary Church Women's hospital will implement the
new breastmilk management system, to be fully live and operable by April 22, 2022, under a budget
of 150,000 USD. The project will install a breast-milk tracker system, which will include a new
application that will be better integrated with the new EMR system (Epic). 10 new scanners will be
purchased to bolster current hardware capabilities. The project will cover all the paediatric and
neonatal patients admitted in the unit with an established Medical Record Number (MRN). The
application will utilize a QR code that the scanners and phones currently being used on the unit
can identify. The application will be used by the nursing staff, lactation staff, and the parents of
admitted patients.

1.3 Milestones
Milestone Description Delivery
Date

Project proposal A proposal is drafted with supporting Evidence Practice clearly 2/1/22
submission outlines, along with clinical implication

Governance WBS approved by governance, including executive level 2/7/22

Review and leadership. Initial budget and resources are also approved by
Approval Decision governance

Architecture PM collaborates with IT to review system architecture and 2/10/22

Review application integration. IT signs off approval on application
architecture compatibility.

Workflow Design Current workflow being implemented is slightly modified to 4/11/22

incorporate new application capabilities. Parent participation is
also factored into a new workflow demand on nursing and
lactation staff.

1
 Hardware 10 additional scanners are purchased to alleviate added strains on 2/14/22
purchase existing hardwares

Milestone Description Delivery

Date

Project Team PM, PPM, IT representative SME, Application owner, Software 2/15/22
Training implementation specialist, system analyst, and staff trainer
performs initial training

Hardware and IT department visits the unit and install and test new computers, 3/21/22
Software installs additional scanners
Installation, and
Application
Configuration

Testing and Issue Initial testing is performed on a workstation Including real-time 3/21/22
Resolution scan and verification of documentation in Epic.

Roll-out/Go-live Hardware Installed to actual computers. Training Provided to all 4/10/22

end-users

User Acceptance Feedback survey distributed and collected. Troubleshoot existing 4/18/22
Training problems based on the feedback

Project-handoff Project is officially handed to Application owner/IT manager 4/23/22

1.4 Phases

Phase Description © Sequence

Project Initiation Defining the project by developing a Project Phase # 1

Charter as well as recruiting the project team.

Project Planning Deciding on milestones, budget, and timeline of Phase # 2

the project while defining tasks and activities as
part of success metrics.

Project Executing Completing tasks and activities that were defined Phase # 3
in the planning phase while keeping team
members and stakeholders informed of progress.

2
Project Monitoring Monitoring the performance of the scanner in live Phase #4
sessions, troubleshooting issues, and staff
feedback session

Project Closing Formal Hand-off is performed along with a Phase # 5

retrospective account so as to define areas for
future improvement and communicate to
stakeholders the ultimate impact of the project.

1.5 Activities

Phase Activity Description © Sequence

Project Develop Quality Develop Scope of the project
Initiation Plan Produce a document describing Quality
Assurance, Control and process review
activities to be undertaken.Define Project
team and request project approval
After the Project Plan but
before the formulation of the
vendor contract.

Project Develop Develop a workflow analysis of nursing After the Project Plan but
Planning Workflow staff and lactation consultants before development of
Analysis training material.

Project Develop Develop in-person training for super After workflow analysis, but
Planning Training users and module training for general before the training of staff.
Material nursing and lactation staff.

Project Install of Install scanner and printer hardware in Installing hardware on the
Executing Hardware order to support the application’s unit to better facilitate
integration into workflow. training and rollout.

Project Super User Train super users so they can be effective After install of hardware on
Executing Training resources on the unit in regards to the unit, but before the actual
application questions and problems. Go-Live.

Project Go-Live Big Bang rollout of application to staff for Once hardware installation
Executing use within the unit. and training is completed.

Project Conduct Communicate to stakeholders the impact After all the project
Closing Retrospective of the project and areas for potential milestones have been
improvement. reached and completed.

1.6 Tasks

Phase Activity Task Sequence

Project Develop ● Develop Scope and goal of the project. 2/1/22

Initiation Quality Plan ● Identify Quality Targets
● Identify Quality Assurance Techniques
● Identify Quality Control Techniques

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 ● Document Quality Plan
● Define Project team
● Request project approval

Project Develop ● Clinical Informaticist observes staff nurses and lactation 2/24/22
Planning Workflow consultants perform job duties on the unit to better
Analysis understand how application integrates into workflow.
● Interviews are conducted regarding previous applications
and how to best integrate application into better
management of breastmilk. 2/25/22

Phase Activity Task Sequence

Project Develop ● Vendor emails a copy of the handout to be printed. 2/28/22

Planning Training ● Hardware purchase request sent to central supply 2/28/22
Material ● Training handout is read and signed for accuracy and 3/4/22
adequacy by two staff trainers.
● Email gets forwarded to hospital print-shop to print 50 3/5/22
copies
● PM confirms delivery of scanners to IT department 3/31/22
● Handout retrieved by staff trainer and transported to the
training site on the day of staff training. 3/10//22

Project Install of ● Software implementation specialist installs scanners to 3//21/22

Executing Hardware the designated computers.
● Software implementation specialist downloads the 3/21/22
appropriate application to the computers.

Project Super User ● Educator from the vendor group gives a presentation and 3/28/22
Executing Training trial session to the super users, staff trainers, unit
manager, and IT SME.
● PM follows up with the trainees for live-feedback on 3/29/22
adequacy of the training.
● Contact information of the educator from the vendor is 3/28/22
released to the staff trainer for further questions.
● Trainees are given one week to perform queries via
correspondence with staff trainers/PM. 4/1/22

Project Go-Live ● Application user interface is released remotely to be fully 4/10/22

Executing able to perform documentation.
● Clinical Informaticist present on the unit to ensure 4/10/22
smooth workflow integration on the day of launch

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Project Conduct ● PM performs site visit on day 1 and day 7 to collect live 4/10/22
Closing Retrospective feedback
review ● Unit manager audits documentations to verify the 4/18/22
scanner is documenting accurately in EHR.
● PM sends out survey email to all users, allows one week 4/18/22
for everyone to respond
● PM collects data from survey and prepares result report 4/22/22
● The PM arranges sessions with a focus group to discuss
the final result of the survey. 4/23/22
● PM communicates to the vendor if any application
modifications may be necessary to accommodate 4/23/22
shortcomings.

1.7 Effort

Task © Effort

● Develop Scope and goal of the project. ● 7 day

● Identify Quality Targets
● Identify Quality Control Techniques
● Document Quality Plan
● Define Project team
● Request project approval

● Clinical Informaticist observes staff nurses and lactation consultants perform job ● 7 days
duties on the unit to better understand how application integrates into workflow.
● Interviews are conducted regarding previously used applications and how to best
integrate application’s utility into better management of breastmilk.

● Vendor emails a copy of the training handout to be printed. ● 1 day

● Request for hardware purchase is sent to central supply ● 2 days
● Training handout is read and signed for accuracy and adequacy by two staff ● 2 days
trainers.
● Two staff trainers replies with a number of training handouts requested. ● 1 day
● Email gets forwarded to hospital print-shop with ticket to print X number of copies ● 1 day
● Handout is retrieved by staff trainer and transported to the training site on the day
of staff training. ● 1 day

● Software implementation specialist installs scanners to the designated computers. ● 1 day

● Software implementation specialist downloads the appropriate application to the
computers.
● 3 days

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 ● Educator from the vendor group gives a presentation and trial session to the super ● 2 days
users, staff trainers, unit manager, and IT SME.
● PM follows up with the trainees for live feedback on adequacy of the training. ● 1 day
● Contact information of the educator from the vendor is released to the staff trainer ● 1 day
for further questions.
● Trainees are given one week to perform queries via correspondence with staff ● 7 days
trainers/PM.

● Application user interface is released remotely to be fully able to perform ● 1 day

documentation.
● Clinical Informaticist on unit to ensure smooth workflow integration. ● 5 days

● PM performs site visit on day 1 and day 7 to collect live feedback ● 7 days
● Unit manager audits documentations to verify the scanner is documenting ● 2 days
accurately in EHR.
● PM sends out survey email to all users, allows one week for respond ● 7 days
● PM collects data from survey and prepares result report ● 2 days
● PM arranges sessions with a focus group to discuss the result of the survey. ● 1 day
● PM communicates to the vendor if any application modifications may be necessary
to accommodate shortcomings. ● 1 day

1.8 Resources
For each task identified, list the resources allocated to complete the task.

Task © Resource

● Identify Quality Targets ● Anup Joshi (Clinical

● Staff Training Informaticist)
● EHR testing ● Eric Wyatt (PM)
● Pripa Plees- (Requesting
Manager)

● Clinical Informaticist observes staff nurses and lactation ● Anup Joshi (Clinical
consultants perform job duties on the unit to better understand Informaticist)
how application integrates into workflow. ● Staff RN’s
● Interviews are conducted regarding previously used applications ● Staff LC’s
and how to best integrate application’s utility into better ● Anup Joshi (Clinical
management of breastmilk. Informaticist)

● Vendor emails a copy of the training handout to be printed. ● Holden Caulfield (Vendor
Representatives)
● Request for hardware purchase is sent to central supply ● Eric Wyatt (PM) and Pripa
Plees- (Requesting Manager)
● Training handout is read and signed for accuracy and adequacy ● Clinical Nurse Educators
by two staff trainers. ● Print-shop
● Two staff trainers replies with a number of training handouts ● Printed Materials
requested.
● Email gets forwarded to hospital print-shop with ticket to print X
number of copies
● Handout is retrieved by staff trainer and transported to the
training site on the day of staff training.

6
 ● Software implementation specialist installs scanners to the ● BioMed staff
designated computers. ● Beatrice Whitlock (IT-SME)
● Software implementation specialist downloads the appropriate ● Software Implementation
application to the computers. Specialist
● Additional Scanners

● Educator from the vendor group gives a presentation and trial ● Super User Group
session to the super users, staff trainers, unit manager, and IT ● Clinical Nurse Educators
SME. ● Anup Joshi, Eric Wyatt (Project
● PM follows up with the trainees for live-feedback on adequacy of Manager)
the training.
● Contact information of the educator from the vendor is released
to the staff trainer for further questions.
● Trainees are given one week to perform queries via
correspondence with staff trainers/PM.

● Application user interface is released remotely to be fully able to ● Beatrice Whitlock (IT)
perform documentation. ● Holden Caulfield (Vendor
● Clinical Informaticist on unit to ensure smooth workflow Representative)
integration on day of launch ● Software Implementation
Specialist

● PM performs site visit on day 1 and day 7 to collect live feedback ● Karen Graham (Project
● Unit manager audits documentations to verify the scanner is Portfolio Manager)
documenting accurately in EHR. ● Eric Wyatt (Project Manager)
● PM sends out survey email to all users, allows one week for ● Pripa Plees- (Requesting
everyone to respond Manager)
● PM collects data from survey and prepares result report ● Florence Nagail - Director of
● The PM arranges sessions with a focus group to discuss the final Nursing
result of the survey.
● PM communicates to the vendor if any application modifications
may be necessary to accommodate shortcomings.

2 Project Plan
2.1 Schedule(Gantt chart)
The Project Initiation started on 1st February 2022. The Project is expected to be completed on April 23rd
with an official handoff of the application to the Unit Manager.

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 2.2 Dependencies

Activity Depends on © Dependency Type

Set-up Project Office Appoint Project Team Finish-to-start

2.3 Assumptions
● There will be no delay for the central supply to secure scanners within projected time.
● Budget approved for purchase and installation of hardware will be made available within time.
● Any bug or malfunction in integration will be identified and reported within one week of go-live.
● There will be no significant event related to the current pandemic that prevents in service from
vendors.

2.4 Constraints
● Budget constraint of 60,000 dollars as approved by finances.
● Lack of resources to customize the application for future unit needs.
● The project needs to be completed within four months, from planning to project completion due
to budget constraints.

3 Workflow Analysis
The workflow of the Angel Eye Milk tracker is based on the user.

1) Parent: This section of workflow is initiated when the parent pumps the milk in a bottle. The parent
logs in the application, selects “Add bottle”, documents the time and amount of milk within the

8
 application. After documentation, the parent can select a printer within the unit, print a label for
the milk, and label the milk. The parent hands over the milk to staff for proper storage.

2) Clinician: The clinician can perform three functions within the application.
a) Receive milk: The workflow is initiated when a parent hands over a labeled milk (from
workflow mentioned above) to the staff. The staff scans the patient label, scans the milk,
confirms the correct patient, date and the content (pumped milk), then documents “Milk
received”.
b) Administer feed: The workflow is initiated when the clinician needs to feed the baby. The
clinician selects “Administer Feed”, attains milk from the refrigerator, scans the patient,
scans the milk, verifies correct milk for the correct baby, feeds the baby, and documents
the time and amount of milk fed in the application.
c) Discharge milk: The workflow is initiated during discharge of the baby. The clinician attains
the milk from the refrigerator, scans the patient, scans the milk, selects “Discharge all”, and
hands off the milk to the parent.
d) Receive donor milk: The workflow is activated when the staff receives milk from a source
other than the parent, in a pre-labeled bottle. The clinician scans the label from the received
bottle, edits the name of the patient and date as needed. The staff selects milk type as
“Fortified milk”, “Thawed Donor milk”, or “Formula Type”. The staff documents the
amount, selects the printer and prints the label. The staff applies the label over the bottle,
and stores the milk in the designated fridge in the unit.

For detailed visual representation of the workflow, please click here Appendix C. Workflow Analysis]

4 Stakeholder Analysis

The stakeholders for the AngelEye Milk Tracker Application are composed of several individuals that are
involved in managing and monitoring the rollout with varying degrees. The Finance Manager, the Central
Supply Manager, and the Director of Nursing have low interest in the project, but can potentially have high
influence over how the program gets done because of their control over resource allocation. Those with
high interest in the project, but with lower influence include patient volunteers, nurse educators, and IT
department specialists who are genuinely interested in the project but do not possess the ability to influence
much of how the project is implemented overall. The clinical informaticist and the portfolio manager play a
part in how the project is implemented because of their efforts, however their influence is subordinate to
others involved in the project. As end-users, the nurses and the superusers have the lowest influence, but
still maintain a high interest in the project. Lastly, because of their close proximity to how the project is
implemented and how quickly the project is executed, the vendor representative, the project manager, the
unit manager, and the systems analyst are the individuals with the highest interest and the highest
influence.

Please click here for detailed information on the Stakeholder Analysis.

5 Risk Reduction

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Using the Failure Mode and Effects Analysis (Appendix E) grid to assign scores for severity of system failures,
Probability of failure occurrence, and Probability of failure detection. The product of all three scores
determined the risk priority for the failure type.

The system will be tested rigorously by the system analyst and the informaticist in presence of the vendor
prior to go-live using scenarios that are as close to a real-world situation as possible. However, following are
anticipated failure risk along with strategies to mitigate them:

Scanner records wrong information: This failure can occur during the scanning of the breast-milk or the
patient. This would possess the highest risk as it has the highest possibility to harm the baby. To mitigate
this, Vendor and staff will test the scanner and the application multiple times to ensure accuracy of the
documentation. In case of failure, the error must be reported immediately by the staff and the SME should
make a full investigation regarding the cause of the mismatch.

Similarly, if the label is not printed correctly, patient identification or breast-milk mismatch can occur, which
can result in possible harm. This step can occur during the step of printing the label. Clinicians must be able
to reprint the label if misinformation is detected. Clinicians will be educated to re verify the information
everytime a new label is printed to ensure safety.

During the initial scanning prior to storing the frozen, pumped, or the donor milk, the scanner may record
wrong information. Since this can cause patient harm, this failure scores high in the FMEA scale. The end-
users will be educated to re-verify the milk composition manually with information recorded by the scanner.
In case misinformation is detected, the staff will be able to make any edits within the application manually.
Staff will be educated to report misinformation immediately and scanners must be interrogated to ensure
proper functionality by scanning and verifying accuracy with other samples. In case of scanner error, back-
up scanners will be available in the unit for the clinicians.

In case of log-in errors, the superusers will be granted authority to document information, print labels, and
store milk for any patient within the unit. The superuser will also be granted the ability to change
passpowers in case the mother forgets her password and is unable to reset it herself.

If barcodes are unreadable, clinicians are trained to revert back to best practices prior to implementation
of the scanners. New staff will be trained regarding proper practice during orientation. If more than one
barcodes are unreadable, the failure must be reported to the vendor via proper channel (SME).

If the label falls-off from the bottle, the milk is unrecognizable, the milk must be discarded. In case a staff
witnesses a label falling, it must be reported to a clinician, who can either print another label, use a blank
label to manually write milk information, or write manually in the bottle using permanent ink to identify the
bottle content.

During server downtime, vendor and IT staff will ensure that patient and milk information is stored within
the Data Loss Prevention (DLP) unit for down-time documentation. The documented data will be uploaded
as soon as the connection is restored.

If a particular scanner malfunctions, back-up scanners will be available for the clinicians to utilize while the
faulty scanner is being interrogated.

If the parent of the baby refuses to use the application, staff will educate the parent regarding the benefits
of using the application and its relation to safety. In case the parent continues to refuse, the clinicians must
revert to the best practice placed prior to implementation of the scanner.

Click here for more information on the full Failure Mode Effects Analysis

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6 Evaluation
Evaluation of the project starts on the day of implementation. During the go-live day, the clinical
informaticist, the project manager, the vendor representative, the IT SME, and the system analyst will be
available for support. The clinical informaticist and the system analyst will be physically present in the unit
to collect active real-time feedback from the end users. The primary goal is not to evaluate the technical
issues with the application, rather perception of usefulness and best integration in the workflow. The
feedback from the end users will be added to a comprehensive feedback sheet.

Two weeks after the go-live, the project manager will send out the application feedback survey for the
usefulness of the application, and the implementation project to all the nurses and the lactation consultants.
The staff will be allowed two weeks to respond. By the end of two weeks, the project manager will prepare
a comprehensive summary of the live feedback and the survey result. The project will be handed over to
the application owner along with the evaluation form.

Please click here for the Post Implementation Evaluation

11
 Appendix A. Project Charter

Angel Eye Milk Tracker

A. General Information

Dr. Barbara Berkovich

Project Sponsor:

Anup Joshi
Project Manager:

Anup Joshi
Prepared by:

02/28/2022
Date:

B. Purpose

The purpose of this project is to implement a new breastmilk management application

throughout the Mary Church Women’s Hospital. This application will replace the currently
utilized application which will require modification to current workflows across the nursing and
lactation departments. This project aims to promote accurate breastmilk administration to
patients and to assist in proper breastmilk inventory management.

C. Constraints and Assumptions

Constraints

● Budget constraint of 60,000 dollars as approved by finances.

● Lack of resources to customize the application for future unit needs.
● The project needs to be completed within three months, from planning to
project completion due to budget constraints.

Assumptions

● There will be no delay for the central supply to secure 10 scanners within
projected time.
● Budget approved for purchase and installation of hardware will be made
available within time.
● Any bug or malfunction in integration will be identified and reported within
one week of go-live.

12
 ● There will be no significant event related to the current pandemic that
prevents in service from vendors.

D. Project Scope Statement

The Neonatal Intensive Care Unit (NICU) in the Mary Church Women's hospital will implement
the new breast milk management system, to be fully live and operable by June 10, 2022 under
the budget of 60,000 USD. The project will install a breast-milk tracker system, which will include
a new application that will be better integrated with the new EMR system (Epic). 10 new
scanners will be purchased to bolster current hardware capabilities. The project will cover all the
pediatric and neonatal patients admitted in the unit with an established Medical Record Number
(MRN). The application will utilize a QR code that the scanners and phones currently being used
on the unit can identify. The application will be used by the nursing staff, lactation staff, and the
parents of admitted patients.

E. Resource Requirements

Budget estimated in USD

Total = 60,000
● Inateck Bluetooth Barcode Scanner, 10 scanner, 70 USD each = 700 USD total
● Initial software integration = 1000
● Staffing budget = 50,000
● Staff Training not included in staffing budget
○ 2 hours in-service for training each super user = 480

Resources

● Project Portfolio Manager/ Project lead

● Two Project Manager
● Clinical informaticist
● Application owner
● IT department to include designated SME for maintenance
● Software implementation specialist along with system analyst
● 2 Staff Trainers (Train Six Super Users)

Technology

● Supporting EHR (EPIC now in-place)

● Designated label scanners
● Verification software

Training documents

● Staff troubleshooting manual

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 ● Staff education pamphlet
● Evaluation survey form, one month and six month post-implementation

F. Risks

● Equipment malfunction
● Not enough time to train all unit staff due to busy workload.
● Increased time burden on staff.
● Increased demand for unit computers and scanners.
● Increased budget constraints on unit
● Staff resistance

G. Success Metrics: Criteria for Evaluating Project Success and Milestones

Milestone Description Delivery

Date

Project proposal A proposal is drafted with supporting Evidence Practice 2/1/22

submission clearly outlines, along with clinical implication

Governance WBS approved by governance, including executive level 2/7/22

Review and leadership. Initial budget and resources are also approved
Approval by governance
Decision

Architecture PM collaborates with IT to review system architecture and 2/10/22

Review application integration. IT signs off approval on application
architecture compatibility.

Workflow Design Current workflow being implemented is slightly modified to 4/11/22

incorporate new application capabilities. Parent
participation is also factored into a new workflow demand
on nursing and lactation staff.

Hardware 10 additional scanners are purchased to alleviate added 2/14/22

purchase strains on existing hardwares

Project Team PM, PPM, IT representative SME, Application owner, 2/15/22

Training Software implementation specialist, system analyst, and
staff trainer performs initial training

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 Milestone Description Delivery
Date

Hardware and IT department visits the unit and install and test new 3/21/22
Software computers, installs additional scanners
Installation, and
Application
Configuration

Testing and Issue Initial testing is performed on a workstation Including real- 3/21/22
Resolution time scan and verification of documentation in Epic.

Roll-out/Go-live Hardware Installed to actual computers. Training Provided 4/10/22

to all end-users

User Acceptance Feedback survey distributed and collected. Troubleshoot 4/18/22

Training existing problems based on the feedback

Project-handoff Project is officially handed to Application owner/IT manager 4/23/22

F. Key Stakeholders

● Executive leaders
○ Requesting Unit Manager (Chad Langston)- requesting implementation of milk-tracker
○ Director of Nursing (Florence Nagail)- for project approval
○ Finance Manager (Bernard Mulah)- for budget approval

● Project Portfolio Manager (Karen Graham)

○ Oversees the overall project and answers to executive leaders on progress of the project.

● Project Manager (Anup Joshi, Eric Wyatt)

○ Oversees the day-to-day operations of the project and reports to the project manager.

● Vendor representative (Holden Caulfield)

○ Delivers the scanner, and software implementation.
○ Ensures timely delivery of the product.

● Application owner (Chad Langston) (Unit Manager)

○ Responsible for the ownership of the scanner post implementation, establishing
relationships with outgoing project managers, and maintaining the equipment and
upgrades/disposes as needed.

15
 ○ Evaluates the project at one month and six months post-handoff.

● IT department to include designated SME (Beatrice Whitlock) for maintenance

○ Responsible for troubleshooting the scanners
○ Responsible for maintaining integration of scanner documentation in the unit EMR.
○ Report impact of new scanner on the overall EHR.

● Software implementation specialist along with system analyst

○ Perform actual implementation of scanner and integrate with corresponding software in
Epic.

● 2 Staff Trainers and six unit superusers (to be nominated one month before implementation)
○ Trains staff on use of the scanner, new features and basic troubleshooting.

● Central Supply manager (Amanda Yarborough)

○ Maintains availability of back-up scanners.

● End-user staff including nurses, nurse educators, and nurse managers.

○ Utilizes the end-product on a daily basis for improved patient care.
○ Reports any software related glitches and safety risk to the Application owner.

F. Executive Summary

The purpose of this project is to implement a new breastmilk management system that will be
implemented at the Mary Church Hospital, NICU unit with 84 bed capacity. The application that will be
utilized as part of this new system will replace the one previously used within the hospital to be better
equipped for the larger global change in the EHR from Cerner to Epic that the hospital has already
completed.

The new system is constrained by the lack of EHR browser button integration, a separate QR code for
patient identification, and an inability to have patient-specific bin labeling. The project assumes that the
current workflows are easily modifiable and the application will be easily integrated into the facility EHR
documentation. The application will also be accessible on Zebra phones that are already in use within the
hospital. The project will cost approximately $60,000 USD to complete and will take approximately 4
months from proposal to implementation. The budget will relate to required hours of training time,
purchase of additional hardware, and the licensing cost.

The project team will consist of stakeholders including a project portfolio manager, two project managers,
designated application owner, a software implementation specialist who will also assume the role of the
subject matter expert, two staff trainers, and six designated power users. The training documents will
consist of a troubleshooting manual, an educational pamphlet for staff and an online survey platform
accessible via the Zebra phones to identify educational gaps and shortcomings.

The main risks to the project will relate to potentially not having enough time to train the necessary staff
in a busy work environment. There may be an increased demand on current hardware which may put a
strain on budgetary constraints. Staff buy-in is never guaranteed and another risk could relate to
resistance from staff if they feel that the application does not help their workload or demands more
documentation.

The major steps of the project will consist of several success metrics instituted over a three-month period.
The project proposal submission will outline the clinical implication of instituting the new system and the

16
project will receive review and approval three weeks later with the budget and necessary resources
included. The initial project training will then begin with super user team members being trained on the
proper use of the program. The hardware will then be purchased, and this portion of the project will be
completed two months after the initial submission. By the end of the next month, the hardware and
software installation will be completed with all of the necessary training material developed for staff
usage. The Go-Live will use the Big Bang method with vendor and super user support. Troubleshooting will
be provided for a total of three weeks after the project is rolled out. After two weeks of the successful go-
live session, two project managers will perform a formal handoff with the unit manager, who will assume
the role of the application owner in collaboration with the IT department. The vendor pledges ongoing
support and guidance.

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 Appendix B. Work Breakdown Structure

WBSAngelEye
MilkTracker

Initiation Planning Executing Monitoring

Project Team Workflow Develop Training Install of Super User

Quality Plan Go-Live Closing
Composed Analysis Material Hardware Training

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Appendix C. Workflow Analysis

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 Appendix D. Stakeholder Analysis

Stakeholder Interview

Category Name Objectives/Questions

Non clinical Staff Beatrice Whitlock (IT - Obtained and retained knowledge of
(could be listed by department SME) application architecture, connection to current
department or EHR system, and User interface for future
agency) troubleshooting. Involved after the project is
approved by the board. Does the program
safely and effectively integrate into the EHR
system without compromising security or
utility?

- Ensured the application implementation is

Software performed correctly with minimal disruption
Implementation to the workflow. Requested application
Specialist modifications from vendors. Involved during
vendor selection. How best can the software
be implemented with minimal disruption to
clinical staff?

- Worked with implementation specialists to

System Analyst monitor effectiveness of the application.
Ensured the application meets the needs of
the units and requested changes with the
vendor. Does the product do what it aims to
do and are the expectations that the vendor
has set been realistically met?

Clinical staff 2 Staff Trainers ( Nurse - Acquired knowledge of effective utilisation of

(could be listed by Educators) the application, user interface, function, and
department or basic troubleshoot. Involved during initial sales
agency) presentation from the vendors. Can the
training team effectively demonstrate to the
clinical staff how the application can and
should be used?

- Understood the basic troubleshooting

Six Unit Superusers
mechanism. Had direct influence over how
bedside nurses encounter and engage with
application. Are the educational materials
provided sufficient to adequately prepare the
bedside nurse for proper utilisation of
application?

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 - Performed real-time application tests and
End-User Staff: 12 Unit provide immediate feedback, continue
Nurses monitoring floor function of the application,
and educate the patient (mother) on
utilisation. As an end-user, they may not fully
understand the lengths it took for the
application to be properly developed and
installed. Is the application meeting the
expectations in real-time on the floor?

- Maintained application, reassess effectiveness

Chad Langston -Unit every month, requests upgrades, replacement,
Manager or removal of application. Communicated with
staff on how the application is being utilised
and if it is properly being integrated into the
nurse workflow. Is this application meeting the
goals and is the application delivering the
metric improvements that the vendor
purported? If not, are the deficiencies related
to staff integration or application utility?

- Prescribed milk orders on which the nurses

must act and utilise application to help
Neonatologists complete. Assumed correct milk is
administered to the correct patient, but does
not have extensive bedside knowledge of how
application is used. Are the nurses able to use
the application in such a way as to correctly
follow feeding orders?

- Offered mothers guidance on how to use

Lactation Consultants
application in conjunction with their pumping.
Used the clinical side of the application to help
the bedside nurse and the mother properly
manage breastmilk inventory. Is the
application assisting the mother properly
manage her milk supply and can it be
integrated into her pumping sessions?

- Helped nurses manage supplies to pump milk,

Medical Assistants such as bottles and labels and assist mothers
in using the pumping machine. Is only
concerned peripherally to the application.

- Fed infants in conjunction with their care plan.

Occupational Assessed how well infants fed and
Therapists administered milk as part of the feeding plan.
Only reasonable concern is related to whether
they are feeding the correct milk amount and
type which the application assists in
confirming. Does this application properly
confirm correct milk administration.

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Admin staff (this
might include Karen Graham ( - Oversaw daily operation of the project every
your practice Project Portfolio morning, supervise the PM, collect progress
manager and Manager) reports, and update requesting manager,
medical director) administration, executive board. Scheduled
project update meetings. Nominated after the
application request is made.

- Oversaw daily progress of the project, collect

Eric Wyatt (Project
data regarding the progress, prepare progress
Manager
report and change request, and update PPM
on daily basis. Nominated by PPM.

- Performed workflow analysis, integration of

Anup Joshi (Clinical application in workflow with minimal
Informaticist) disruption.Is this application easily
integratable into the bedside nurse’s
workflow?

Florence Nagail - Requested implementation of milk-tracker.

(Director of Nursing)

Amanda Yarborough- - Performed actual purchase, acquisition, initial

Central Supply hardware inspection, storage, and delivery of
Manager the scanners in a timely manner. Involved
after the budget approval for initiating
purchase.

Vendors Vendor Representative

- Educated client team on deliverables, collects
change requests, represents vendors during
final contract signature. Involved throughout
the project on an “as-needed” basis until the
final project handover. Excluded from budget
resources. Are the client expectations and
needs being appropriately met or exceeded?

Patients Patient volunteers - Volunteered to provide feedback on usage,

committee effectiveness, and current issues on the
representatives patient side. Invited to update meetings.
Dynamic nomination on a volunteer basis. Is
the mother side of the application easy to use
and understand?

Bernard Mulah - Reported available budget, allocated and

Finance (Finance Manager) approved requested budget, approved budget
changes, delivered financial resources in a
timely manner. Are the financial costs of the

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 project being appropriately adhered to
without exceeding budget?

INFLUENCE / INTEREST GRID

High KEEP SATISFIED MANAGE CLOSELY

Bernard Mulah (Finance Manager) Vendor Representative

Amanda Yarborough (Central Supply Chad Langston (Unit Manager)

Manager)
System Analyst
Florence Nagail (Director of Nursing)
INFLUENCE Eric Wyatt (Project Manager)
Neonatologists
Anup Joshi (Clinical Informaticist)

Project Portfolio Manager

Low MONITOR KEEP INFORMED

Occupational Therapists Patient Volunteers Committee

Representatives
Medical Assistants
2 Staff Trainers (Nurse Educators)

Beatrice Whitlock (IT department SME)

Software Implementation Specialist

Six Unit Superusers

End-User Staff: Unit Nurses

Lactation Consultants

Low INTEREST High

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Appendix E. Failure Mode Effects Analysis

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25
 Appendix F. Post Implementation Evaluation

1 INTRODUCTION

1.1 Project Identification

The AngelEye MilkTracker is project 009295163 and is a project to rollout a system to help
clinicians and parents track the breastmilk. The system, after implementation, is being referred to as
AngelEye MilkTracker and will further be referenced as ANGMT.

1.2 System Proponent

The lead system proponent was the unit manager of the NICU at Sharp Mary Church Hospital, Chad
Langston.

1.3 History of the System

The system had a predecessor compatible with the Cerner EHR, known as Cerner Bridge. Once Sharp Mary
Church went to EPIC, Cerner Bridge was no longer operable within the unit so the unit reverted back to the
original double RN check for breastmilk storage and administration. The rollout of AngelEye MilkTracker
is aimed at helping the clinician return to a more precise process by helping them accurately storek,
effectively prepare, and safely administer milk. The system was already constructed by the vendor and used
data stored locally on the hospital server. The data is used in real time to check and reinforce clinician’s
action as it relates to breastmilk.

2 EVALUATION SUMMARY

2.1 General Satisfaction with the System

Many users are satisfied with the application and find it useful in properly managing breastmilk in the
clinical setting. Both nurses and mothers report high participation with the application and comment on how
user-friendly it is to utilize while being practical in its overall functionality. The strengths of the system
include the ease in physician order compliance when it comes to milk preparation and the safety promotion
when it comes to proper breastmilk administration. The NICU, post-implementation, reported zero milk
administration errors 3 months after Go-Live. Some nurses have reported problems opening the application
on the web browser, however, there have been no problems with opening the application on the Zebra
phones. Also, some parents have reported that the application’s QR sensitivity in scanning can be difficult
to perform. The most used features are with the clinician side of the application and they relate to the milk
administration, milk preparation, and milk receival functions. The least used features are the receival
function on the parent’s portion, as well as the receival of formula on the clinician portion. The application
has an option of having a chatbox to enable communication between the clinician and parent, however that
feature is disabled by the unit and is not used at all. Improvements should focus on making the scanner
more sensitive, especially in darker environments, and on better integrating the web browser access of the
application into the clinician’s workflow.

2.2 Current Cost-Benefit Justification

The system is not paying for itself because of the subscription cost that must be paid on a yearly basis. The
anticipated benefits of continued safe and precise breastmilk management has been determined to justify the
continued cost. The unit has reported a 95% staff utilization as of 3 months after implementation with zero
milk errors in administration or preparation. This change should be maintained as permanent with continued
integration into the clinician workflow. Based on the overall reduction in milk errors and better inventory
management that promotes feeding the NICU patients properly stored and prepared breastmilk, the
application has been and continues to be cost-justifiable for the unit.

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2.3 Needed Changes or Enhancements

Because the unit is largely satisfied with the application, the magnitude of effort needed to improve or
change the system is minimal because the application largely functions as intended. The suggested
changes include making the QR code more sensitive in the dark and will involve the vendor running
more tests and improvements for future updates to the application. This change will require one IT
staff member to be the point of contact and to communicate with the program manager on the ultimate
success of any improvements. This change is considered a moderate priority. The most important
change is to allow the application to be launched from the EHR since clinicians are complaining that
the application is difficult to access from the web browser. This will involve the implementation
specialist communicating with EPIC so as to include web browser launch capability from the toolbar.
Once this is added, clinicians will be better able to open the ANGMT application from the EHR
program. This is considered high priority and may ultimately require the participation of the vendor
representative and the clinical informaticist.

3 ANALYSIS AND IMPLEMENTATION

3.1 Purpose and Objectives

The original purpose of the application and the objectives have largely been achieved. The overall goal of
getting at least 95% of breastmilk in the fridge properly labeled, getting at least 95% of staff performing a
scan of milk prior to administration, and getting at least 95% of milk scanned for discharge processes have
all been achieved three months after implementation. Moving forward, the unit will aim to achieve a
complete 100% compliance rate and will continue to promote usage of application by mothers. Proper
education and encouragement will allow for a precise objective to be formulated in conjunction with the
utilization rate among mothers.

3.2 Scope
The scope and limitations of the project were maintained during implementation. The project was
within budget and did not extend to any other unit or staff that was not originally included in the
project plan.

3.3 Benefits

One quantifiable benefit of implementing the ANGMT application was getting approximately 98% of milk
properly labeled in the fridge for storage. The reason that this did not reach the 100% planned compliance
was attributed to time that staff indicated they did not have to print labels for milk brought in by the mother.
The staff with these responses were given further teaching on the ease of usability inherent in the
application. The application also had the benefit of having approximately 96% of staff performing a scan of
milk prior to administration. The reason this did not reach the planned 100% compliance was attributed to
staff who insist on continuing to use the obsolete process of double RN check for milk administration. The
staff with these responses were given further teaching on how the phone can serve as the check with no
need to involve other staff who may not potentially be available to assist when time management is
paramount. The last quantifiable benefit of implementing the ANGMT application was getting 95% of milk
scanned as part of the discharge process. The reason for this was determined to be that staff forgot to scan
the milk as part of the discharge process. Plans have now been implemented to incorporate milk retrieval
and scanning in the discharge workflow. Lastly, the non-quantifiable benefit of having staff report that they
now treat milk as a more precise endeavor such as medication has allowed for proper adherence to the
scanning and storage that the application aimed to accomplish.

3.4 Development Cost

The development cost of the project was estimated to be approximately 150,000 US dollars. The ten
scanners were purchased for 80 USD each with 200 USD required for installation which matched the

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estimate. The initial licensing cost was 30000 USD which matched what was estimated. The yearly
subscription would be 10000 USD and the project manager that was subtracted from an outside agency cost
50000 USD which was as estimated. The staffing budget was estimated at 55000 USD however, it only cost
53435 USD because less staffing hours were needed for installation and testing. The development of the
training material was estimated to be 3500 USD however, it cost 3235 USD to develop and disseminate
because less time was required to develop the materials. The 2 hours in-service training that was given to
the SuperUsers were needed and matched the estimate. This means that the entire project cost 148170 USD
which was 1830 USD below budget.

3.5 Operating Cost

The operating cost is estimated to be 10000 USD yearly. This estimate is adequate because the contract
between the hospital and the vendor requires the vendor to be responsible for maintenance and update. The
IT staff are considered the resources required which assist and sustain the project, but this is the normal
course of their already defined job description.

3.6 Training
The training of all of the users was adequate before implementation. All of the end-users indicated by
survey that they understood how the application works and how to incorporate it into their workflow.
They also reported that they knew this information before the Go-Live took place. The training and the
use of SuperUsers proved to be valuable tools and were appropriate to accomplish a successful project
launch. Additional training materials related to troubleshooting how to perform scans that are difficult
to complete and how to encourage mothers that are not receptive to utilizing the application. The
training will be provided as handouts on the unit at the clerk’s desk for easy dissemination.

4 OUTPUTS

4.1 Usefulness
18 out of 20 users reported that the application was moderately useful. One comment stated “While
the application enhances the safety for the babies, it is still possible to feed without the scanner
application.” General consensus is that the application is definitely a welcome addition to the
workflow due to minimal disruption and meaningful use.

4.2 Timeliness
The scanner documented patient and milk information without any delay. Due to the autofill
feature of the scanner, documentation is much faster than manual data input.

4.3 Data Quality

No reported error in documentation and the scanner identified correct data in all instances.

5 SECURITY

5.1 Data Protection

All data was uploaded to Epic EHR directly and the mother controlled the information input via the
mobile application. No breach of privacy was reported during the survey.

Disaster Recovery
The application stored all input internally in the mobile or the unit computer during downtimes. The
data was successfully uploaded to the EHR and DLP unit as soon as connectivity was restored. No data loss
occurred.

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5.2 Audit Trails
The application maintained a complete record of log-ins and activities including scans.

5.3 System Access

The application required password verification for each login in the personal mobile access while
required staff to log into Epic and establish patient-caregiver relationship prior to accessing any data. No
display or breach of data confidentiality was reported.

6 COMPUTER OPERATIONS

6.1 Control of Workflow

Due to recency of implementation, no significant disruption to workflow or change was
recommended by the end-users.

6.2 Scheduling
No scheduling issue was reported.

6.3 EHR User Interface

During the past three weeks, over 2000 feeds, 1200 milk storage and 50 milks were discharged. 5
discharges were unscanned real-time due to local internet outage, but information was uploaded
immediately after connection was restored. No inaccurate documentation reported.

6.4 Computer systems

During downtime, the unit scanner scanned 5 discharged milk, stored data locally, and successfully
uploaded to EHR immediately after connection was restored.

6.5 Peak Loads

No lag in scan was noted during the peak hours.

7 MAINTENANCE ACTIVITIES
The purpose of this section is to evaluate maintenance activity involving the EHR system software and
all hardware components.

7.1 Activity Summary

No specific maintenance or repair was requested. Due to the small scale of the application, minimal
bandwidth was dedicated to the application.

7.2 System Maintenance

The application will be formally handed to the unit manager (Chad Langston) who will act as the
owner and the POC for any application related issues. The owner will be responsible for escalating
technical issues to the IT, yearly usage evaluation, decision to dispose or replace application,
license renewal, and upgrade budget. The IT department will be responsible for technical
maintenance to include compatibility with future Epic upgrades, troubleshooting, maintaining
network connectivity, data connectivity with EHR, usage reports, and reported error logs.

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