In my experience with implementation plans, I have found that there needs to be a fair level of detail in order to ensure project success. The implementation should be divided into phases that detail who will complete each activity, a timeline for each activity’s completion, and when the the activity has been completed. Each activity should be defined using a standard work breakdown structure (WBS) methodology.
I have found that mostly the vendor has a standard WBS with project phases that is adaptable per to each organization. As the vendor knows the software the best (i.e., tech requirements, past successes and failures of implementation), it should be written in to the request for proposal (RFP) that the vendor include the standard implementation documentation along with their response. By reviewing each of the vendors proposed implementation plan, the organization will be better prepared for allocating resources, planning technical purchases, and scheduling the project.
By having a detailed implementation plan in hand prior to the final vendor selection, the organization will be better prepared to know actual costs of the implementation and planning the application launch. Some of the pros and cons of having a detailed implementation plan include:
Pros for Detailed Implementation Planning
1. Detailed planning details individuals. A detailed implementation plan should include the specific activities associated with at each phase of the project. A detailed plan should include the identity of the individual(s) responsible for completing the work. This is an advantage for the project manager, as the project manager will know who to check in with during implementation.
2. Detailed planning facilitates better time management. By compiling a detailed plan of all theproject activities, a more accurate project schedule can be created. As many organizational IS resources, vendor resources, and departmental resources have to be scheduled and budgeted for; the more detail the plan, the more accurate the project schedule.
3. Detailed planning for better project implementation reporting. During the implementation of the project, it is important for the project manager to update the project sponsor as to the progress of the project. By having a detailed plan, reporting project status is easier for the project manager.
4. Detailed planning facilitates better communication. As the project manager will need to keep track of the completed activities of the project, having a list that details who is doing what will be very useful when the project manager when he/she needs to get project updates.
Cons for Detailed Implementation Planning
1. Detailed implementation plans take time to prepare. A standard breakdown of project activities and phases may exist from the vendor, but these will have to be customized for each organization. This type of planning can take a long time and details that address the project resources and schedule can sometimes be hard to accurately estimate.
2. Detailed implementation plans are subject to change. During theimplementation planning phase and the actual implementation, many changes may have occurred, which will be a burden for the project manager to maintain these changes.
3. A detailed plan may not be necessary. For custom-built IT solutions, detailed plans may not be feasible. For IT projects that entail a customized software be built, it may be better to use a Kanban or Agile project methodology that would not require detailed implementation plans.
The approximate annual cost of healthcare data breaches is $6.5 billion, and for organizations that are victims of a data breach the approximate economic impact is $2.2 million (Perna, 2012, p. 20). Health care organizations (HCO) should take the following steps to better reduce the risk of a data breach:
1. Invest in educating their staff; in order, to reduce the improper handling of PHI. HCOs should automate the encryption process as much as they can.
2. Update outdated processes. For example, HIPAA requires 128 bit encryption of PHI, but 128 bit encryption has been known to cracked by hackers in a matter of hours, so organizations need to update their encryption standard in order to protect their data (Mick, 2010).
3. HCOs must evaluate their entire processes regarding data security, organization-wide. My department has many of its own policies that are different from the organizations, and for departments like mine, an evaluation of process might yield potential places where data may be compromised.
4. The biggest cause of data breaches by HCOs in 2011 was by the portable devices that were stolen or lost (Perna, 2012, p. 20). HCOs should adopt virtualization and prevent data from being saved to portable devices. Also, by installing encryption software to USB devices that can be given to employees, the threat of data breach by lost or stolen devices will be greatly reduced.
5. Investigate and take the proper legal action, when entering into contracts with third party vendors. Data security questions should be a focal point in all RFPs and negotiations with third party vendors.
6. HCOs need to adoptHIPAA Audit Protocols to be in compliance with HIPAA (Sheldon-Dean, 2012).
HCOs need to take a proactive role when approaching data security, and data breaches should not be underestimated. As more PHI goes digital and hackers invade HCOs, a proactive approach is the best way to prevent data breaches.
Mick, J. (2010, January 10). Researchers crack 3G GSM 128-bit encryption in under 2 hours. Retrieved on September 7, 2013 from http://www.dailytech.com/Researchers+Crack+3G+GSM+128bit+Encryption+in+Under+2+Hours/article17417.htm
Perna, G. (2012). Data security 101: Avoiding the list. Health Informatics, 29(9), 18-21.
Sheldon-Dean, J. (2012, October 2). Mitigating the top five HIPAA security issues. Proceeding of the 2012 American Health Information Management Association Convention, USA.
With the proliferation of the electronic health records (EHR) and the digitization of paper medical records, as federal funding through meaningful use has increased the number of physician practices that have adopted EHRs, so has the risk ofdata breaches increased (Perna, 2012, p. 18). In 2011, more than 10.8 million people had their protected health information (PHI) compromised, up from 5.4 million in 2010 (Perna, 2012, p. 18). That brings the three year total of individuals affected by data breaches to over 19 million (Perna, 2012, 20). These are staggering numbers, and the risk of data breaches need to be addressed. Some of the biggest causes of PHI loss, in no particular order, are:
1. Improper encryption education of medical workforce (Perna, 2012, p. 20; Sheldon-Dean, 2012).
2. Manual and outdated processes are still in use (Perna, 2012, p. 18).
3. Standards and best practices are incoherent or overlapping (Sheldon-Dean, 2012).
4. Security of portable devices and access by remote users allow for remote storage of PHI that is later lost of stolen (Sheldon-Dean, 2012; Perna, 2012, p. 20).
5. Breach of PHI by third-party vendor (Perna, 2012, p. 20).
6. Compliance information that is incomplete (Sheldon-Dean, 2012).
7. Unintentional employee breach (Perna, 2012, p. 20).
8. Data breach caused by unintentional system error (Perna, 2012, p. 20).
9. Theft of data by criminal attack (Perna, 2012, p. 20).
With 57 percent of physicians already using electronic health records (EHR) systems in 2011 (Birk, 2012, p. 21), deconstructing some of the primary drivers of EHR implementation can help the minority of physicians who have yet to dive into the EHR market. According to Ross and Berth (2002), all IT investments can be categorized into four types, which serve as primary drivers to support a request for a new EHR system. The four classes of IT investments are:
Based on Ross and Berth’s four types of IT investment, implementing a new EHR system would either be categorized as a transformation investment or a process improvement. The six reasons or systems projects are: improved service, support for new products and services, better performance, more information, stronger controls, and reduce cost (Shelly & Rosenblatt, 2012, pp. 59).
Four Factors Driving Health IT Adoption
1. Better Performance/Reduced Cost - With the Centers for Medicare and Medicaid Services (CMS) pumping additional funding to physicians who adopt an EHR system through its EHR incentive program, now more than ever is it beneficial for physician practices to adopt an EHR system. Most private practices would only qualify for the Medicare track of funding through the EHR incentive program. The EHR incentive program looking to improve provider performance, while reducing costs to physicians.
2. Stronger Controls - It is imperative that the new EHR system allows for a secure platform that allows for existing workflows to be adapted to the system. The EHR system needs to be open enough to allow physicians and administrators to complete their work, while also maintaining a secure environment free from bad data and data breaches. By implementing a new EHR system, the organization can better protect itself from data theft and support the company’s business needs (Shelly & Rosenblatt, 2012, p. 60).
3. More Information - By implementing an EHR system, physician practices will be able to analyze patient data in a way that was not possible with their paper charting system. These services then can be marketed and relayed to the physician practice's patients (Shelly & Rosenblatt, 2012, p. 60).
4. Improved Service and Outcomes - As meaningful use is focused on increasing patient health, adopting an EHR also fits into most physician practices strategic plan or mission. As physician practices become more comfortable with their EHR system, they will be able to offer more efficient customer service and patient care.
Birk, S. (2012).E-partners: Innovative strategies for hospital-physician EHR integration. Healthcare Executive, 27(5), pp. 21-28.
Shelly, G. B., & Rosenblatt, H. J. (2012). System analysis and design (9th ed.). Boston, MA: Course Technology - Cengage Learning.
Ross, J., & Beath, C. (2002). Beyond the business case: New approaches to IT investment. In K. A. Wager, F. W. Lee, & J. P. Glaser (Eds.), Health care information systems: A practical approach for health care management (2nd ed.) (pp. 417-418). San Francisco, CA: Jossey-Bass - An Imprint of Wiley.
Whitten, J. L., & Bentley, L. D. (2007). Systems analysis and design methods. (7th ed.). New York, NY: McGraw-Hill/Irwin.
Developing a taxonomy for choosing which system development methodologies or strategies an organization will use to decide of which information system to implement is much like deciding which equations one might choose to solve an algebra problem. While there are many ways to arrive at a solution, there are many rules to choose from. Many variables must be collected and evaluated before deciding on an optimal methodology or strategy.
According to Whitten & Bentley (2007, p. 92), three considerations need to be analyzed prior to deciding on a system development methodology or strategy. The three considerations are:
- If the methodology is product-driven, is a prototype to be built or is code going to be written?
Organizations using this evaluation method will be better positioned to decide on which system development methodology or strategy to use when implementing an information system. Where this strategy fails is that is does not consider the information system’s return on investment (ROI), employee usability, alignment with corporate culture, or reasoning behind the purchase. It is also important to conduct a thorough investigation of the viability of the information system companies that are under consideration, by evaluating publicly available information.
Whitten & Bentley (2007, pp. 77-78) also suggest conduction the PIECES Problem-Solving Framework Checklist, prior to deciding on a methodology. The PIECES method includes:
Whitten & Bentley (2007, p. 94-104), suggest the following additional methodologies:
System Development Methodologies for a Large Community Hospital
Model-Driven Development Strategy
As a large community hospital is likely to have a host of existing systems, the model-driven development strategy would be a good systems development approach. According to Whitten & Bentley (2007, p. 94), the model-driven development strategy includes more commonly known methods that may make implementation easier than other methods. This method requires a good deal of planning and when implementing a new system, this is a good thing. A model-driven development strategy also allows for more thorough documentation, easier validation and conceptualization as models are visualized, and better built systems as they are more thorough diagrammed the first time compared to other strategies (Whitten & Bentley, 2007, p. 96).
System Development Methodologies for a Private Physician Practice
The Commercial Application Package Implementation Strategy
Regardless of the EHR System a private physician practice decides to implement, in most cases some degree of customization is likely to occur. But for the most part, existing commercial EHR systems will be ready for small practices right out of the box. A CAPIS strategy would be an ideal solution as this allows for the submission of requests for proposal (RFPs) to reviewed by the physician practice (Whitten & Bentley, 2007, p. 101). CAPIS allows for rapid implementation as the heavy programming has already been done by the EHR vendor, requires less “in-house” development knowledge and expertise, and allows for a more cost effective solution as the system can be duplicated to multiple users (Whitten & Bentley, 2007, p. 103).
Agile Method/Spiral Model
EHR Vendors may also benefit from the use of the spiral model to decrease the risks associated with software development (Houston, 2011, p. 45). As prototypes are developed, risk analysis occurs iteratively, so the product develops on an evolving basis (Shelly & Rosenblatt, 2012, p.26). The agile methodology allows for rapid development and testing, and also allows for flexibility and responsiveness by developers (Shelly & Rosenblatt, 2012, p.26). The agile methodology may pose some challenges to EHR Vendors who are not familiar with the methodology. The Project Management Institute (PMI) offers an agile certification through its PMI Agile Certified Practitioner (PMI-ACP) certification (PMI, 2012). EHR vendors that utilize agile methodologies would benefit from acquiring professionals who possess this certification.
Other barriers to effectively implementing an agile methodology include a lack of structure that can introduce greater risk, increased scope creep, and an increased level of communication by all team members (Shelly & Rosenblatt, 2012, p. 26). Houston (2011, p. 45) argues that increased risk is not associated with an agile method/spiral model, as risk analysis can be conducted iteratively (see Figure 5-2).
EHR Vendors would also benefit from incorporating this methodology. As the various objects emerge when planning a new technology, having an O-O methodology will help when breaking down responsibilities to various in-house team members.
Implementing a new technology is a big undertaking for any organization. For some leaders compiling too much data can result in a “decidophobia,” a clinical fear of reaching a decisions (Useen, 2010, p. 514). Leaders that suffer from decidophobia can take advice from the U.S. Marine Corp and adopt a 70 percent solution, which states that if a leader “has 70 percent of the information, has performed 70 percent of the analysis, and feels 70 percent confident, he or she is instructed to decide” (Useen, 2010, p. 514).
Houston, S. M. (2011). The project manager’s guide to health information technology implementation. Chicago, IL: HIMSS.
Project Management Institute. (2012). PMI-Agile Certified Practitioner (PMI-ACP)SM Pilot Program. Retrieved August 22, 2013 from http://www.pmi.org/certification/new-pmi-agile-certification/pmi-agile-certification-pilot-program.aspx
Shelly, G. B., & Rosenblatt, H. J. (2012). System analysis and design (9th ed.). Boston, MA: Course Technology - Cengage Learning.
Useem, M. (2010). Decision making as leadership foundation. In N. Nohria & R. Khurana (Eds.), Handbook of leadership theory and practice (pp. 507-525). Boston, MA: Harvard Business Press.
Whitten, J. L., & Bentley, L. D. (2007). Systems analysis and design methods. (7th ed.). New York, NY: McGraw-Hill/Irwin.
Recent research shows that mHealth apps can: provide rural patients with two times greater access to care; decrease data costs by up to 24%; and save seniors up to 25% in their medical costs (1). In order for HCOs to implement a wireless network that supports mHealth apps for patients, a review of wireless network architecture, standards and topologies is necessary.
According to Shelly & Rosenblatt (5), there are seven specific issues that must be addressed when establishing a system architecture, they are:
1. Enterprise resource planning (ERP)
2. Initial and total cost of ownership (TCO)
4. Web integration
5. Legacy system interface requirements
6. Processing options
7. Security issues
Having considered the aforementioned system architecture issues, HCOs can begin planning the data and access methods, the applications programs needed to handle the processing logic, and the interface that will allow users to interact with the system (5). A HCO may choose to support their system architecture by establishing a local area network (LAN) or a wide area network (WAN), both of which allow the sharing of data and hardware between servers, clients, and hardware like printers and scanners (5). HCOs will also have to decide how to establish the client/server architecture.
Depending on the HCO’s needs the organization has the option of setting-up a central data processing center, central server with remote terminals, a stand alone client , a two-tiered client/server, or a three-tiered client/server architecture (consisting of a data server, application server, and a client) (5). Finally, the HCO will need to model the topology of the system. The system architecture should include: network topology - that shows how the network is configured; physical topology - that shows the actual network cabling and connections; and logical topology - that shows the way the components interact (5).
Wireless networks are established by configuring a wireless local area network (WLAN) (5). There are three types of wireless network topologies: the Basic Service Set (BSS) establishes wireless access points that are used to serve wireless clients; the Extended Service Set is made up of two or more BSSs, which extend the wireless access area; and the Independent Service Set, which uses no access point and wireless clients are connected to each other directly (5).
1. Culp-Ressler, T. (2012, September 27). How smartphones are facilitating better health care. Retrieved August 21, 2013 from http://thinkprogress.org/health/2012/09/27/923021/smartphones-better-health-care/?mobile=nc
2. Dolan, B. (2012, January 16). Each month 16.9M access health info via mobiles. Retrieved August 21, 2013 from http://mobihealthnews.com/15905/each-month-16-9m-access-health-info-via-mobiles/
3. Jarrin, R. (2013, June 13). HIMTA - take II: Fostering innovation and entrepreneurship in wireless health. Retrieved August 21, 2013 from http://www.qualcomm.com/media/blog/2013/06/13/himta-take-ii-fostering-innovation-and-entrepreneurship-wireless-health
4. Gold, J. (2012, September 26). Lawmaker pitches new FDA Office of Mobile Health. Retrieved August 21, 2013 from http://www.kaiserhealthnews.org/Stories/2012/September/27/FDA-Mobile-apps.aspx
5. Shelly, G. B., & Rosenblatt, H. J. (2012). System analysis and design (9th ed.). Boston, MA: Course Technology - Cengage Learning.
The rapid growth and development of mobile technology in healthcare demands that health IT departments have the proper IT architecture to deliver wireless access to wireless networks within a health care organization (HCO). With an average of 16.9 million people accessing their health information via a mobile device a month, which represents a 125% increase from 2010 to 2011 (2), HCOs who are not prepared to enable the mobile retrieval of health information (mHealth) are at risk of being left behind.
With over 40,000 mobile health apps to date(1), the mHealth market poses a challenge for consumers and providers as the claims and accuracy of mHealth apps have yet to be regulated by the US Food and Drug Administration (FDA). With the introduction of the Healthcare Innovation and Marketplace Technologies Act (HIMTA) later this year to the US House of Representatives(3), the FDA Office of Mobile Health would be responsible for ensuring mobile health app accuracy and oversight(4).
The intention of enterprise resource planning (ERP) is the aggregation of all departments and functions into one computer system(3). In order for hospital leadership to make better informed decisions, evidence-based decisions must be the backbone of effective leadership. Implementing an ERP solution can help to meet these objectives. An ERP solution can assist healthcare leaders by:
“aligning resources with best practices and improved financial outcomes; optimizing patient safety and outcomes while achieving needed financial return; and driving sound decision-making through real-time access to key business performance metrics”(4).
Utilizing an ERP solution’s dashboard allows healthcare leaders to better manage their finances across all departments, which helps streamline reporting, budgeting and compliance requirements.
Key ERP Value Points
- Cost Savings
Effective ERPs save companies and average of 1.6 million annually(3). ERPs offer hospitals with a variety of cost saving solutions including: budgeting; financial management accounting; financial supply chain management; & cost and profitability management(1). From a strategic standpoint, having all departmental financial data in one system is an invaluable asset to healthcare leaders.
- Meaning from Data
The power of an ERP to evaluate data and find meaningful answers regarding departmental spending and outstanding invoices are benefits of adopting an ERP.
Some Risks of ERP Adoption
- Start-up Costs
Implementing an ERP is costly and is a considerable investment that can take on average 8 months to realize any benefits(3). Organizations operating on thin margins will find the start-up costs associated with ERP implementation a barrier to their adoption.
- Time Investment
Establishing an ERP can take 6 months or more to implement(3). The required time needed to implement an ERP solution may not be feasible for all organizations.
- Failure to Implement an ERP Solution
As with any IT project, the risk of failure is present. IT projects across the board have a 65% failure rate. Detailed plans and risk analysis should be conducted prior to investing in and new IT solution.
Blueprinting is Key
Implementing an ERP is a serious undertaking that requires proper blueprinting(2). Involving key stakeholders from the beginning and listening to their feedback during ERP planning will help to decrease the risk of ERP failure(2,3). Proper blueprinting will also help to establish the intended goals of the ERP once it is operational.
1. SAP. (2005). Enterprise management and support in the healthcare industry. Retrieved on August 19, 2013 from http://hoffmanmarcom.com/docs/mysaperp_sod_healthcare.pdf
2. Sahadevan, D. (2011, June 11). Healthcare ERP Implementation. Retrieved August 19, 2013 from http://www.hospitalinformationsystem.com/2011/06/healthcare-erp-how-do-i/
3. Wailgum, T. (2008). ERP definitions and solutions. CIO. Retrieved August 19, 2013 from http://www.cio.com/article/40323/ERP_Definition_and_Solutions
4. McKesson. (2013). Enterprise resource planning. Retrieved August 19, 2013 from http://www.mckesson.com/providers/health-systems/department-solutions/enterprise-resource-planning/
Resnick & Alwan, observed the growth of many health information technologies (HIT), in home health and hospice (HHH) agencies, as they related to the seven years between 2000 and 2007.(7) As the supply of hospital beds is shrinking, and globally the number of persons 60 and older is expected to be 1.2 billion by 2025,(5) the need for home health services is expected to rise. HIT will be an essential key to improving the efficiency of HHH quality and service.(7) Electronic medical records (EMR), telemedicine & telehealth, and point of care documentation (PoCD) will be vital to the future success of home health care.
EMRs are the core system for recording the details regarding a patient’s care and they serve as the backbone for other HIT. As HHH becomes more vital and as the population ages, hospitals are expected to decrease their readmission rate. Hospital-at-home units are being established at hospitals around the country to help address the need to lower the readmission rate.(6) As hospitals have a higher EMR adoption rates overall, they are better positioned to offer HIT to HHH care in order to achieve better health outcomes (See Figure 1).
Releasing patients to their home for care or a hotel, as has been pioneered in England(1), may require their condition to be monitored remotely. Remote health monitoring devices, offers the ability to allow machine-to-machine transmission of vital data in real-time using mobile technology.(4) A telemedicine link allows HHH caregivers to connect to physicians, which can save patients from unnecessary visits to the ED.
Also the use of PoCD mobile devices, such as iPads or personal digital assistants to record visit notes in the patients EMR, are another key HIT in HHH care.(7) In 2007, 29% of HHH agencies had adopted some kind of PoCD.(7) A further increase in PoCD use will lead to better HHH care, a decrease in the probability of errors and promotion of information transfer.(2)
1. Anonymous. (2010). London hospital defends putting patients in top hospitals. BBC. Retrieved on August 17, 2013 from http://www.bbc.co.uk/news/uk-england-london-11708963
2. Duffy, W. J., Kharasch, M. S., Morris, S., & Du, H. (2010). Point of care documentation impact on nursing-patient interaction. Nursing Administration Quarterly, 34(1), E-1 - E-10. doi:10.1097/NAQ.0b013e3181c95ec4
3. Gur-Arie, M. (2012). 2011 EHR Adoption Rates. Retrieved March 6, 2012 from http://thehealthcareblog.com/blog/2011/12/02/2011-ehr-adoption-rates/
4. Horowitz, B. T. (2012). Sprint, Ideal Life unveil remote health monitoring device at CES. Retrieved on August 17, 2013 from http://www.eweek.com/c/a/Health-Care-IT/Sprint-Ideal-Life-Unveil-Remote-Health-Monitoring-Device-at-CES-120182/
5. Keckley, P. H. (2008). Connected care: Technology-enabled care at home. Retrieved on August 17, 2013 from http://public.deloitte.com/media/0285/us_chs_ConnectedCare_0308.pdf
6. Lega, F., & Calciolari, S. (2012). Coevolution of patients and hospitals: How changing epidemology and technological advances create challenges and drive organizational innovation. Journal of Healthcare Management, 57(1), 17-33.
7. Resnick, H. E., & Alwan, M. (2010). Use of health information technology in home health and hospice agencies: United States, 2007. Journal of American Medical Informatics Association, 17, 289-295. doi:10.1136/jamia.2010.005504
As with any new IT solution, there are going to be some challenges and limitations, cost being one of them. While federal funds are available for those providers who can attest to meaningful use compliance, start-up costs associated with ePrescribing are expensive.
Clinical practices will have to have an EHR that is compatible with an ePrescribing software like SureScripts and have a plan to exactly the solution will be implemented, including workflow. Most practices will also have to purchase an automated dispensing cabinet (for their on-hand drug supply) and a barcoding system (to track drug supplies). Only recently have controlled substances, like narcotics, been approved to be sent by ePrescribing technology, so for many paper prescriptions may need to be written for controlled substances(1). Also penalties may be levied by CMS if not adopted(2).
1. Anonymous. (2012, February 15). E-prescribing of Controlled Substances - The Future of Electronic Prescribing. Retrieved April 2, 2012 from http://www.youtube.com/watch?v=A1Oxyv-Q0rQ
2. Pawola, L., & Kho, A. (2011). An introduction to e-prescribing. Retrieved August 8, 2013 from http://www.ilhitrec-ed.org/uploads/2/8/2/4/2824628/il-hitrec_e-prescribing_webinar_presentation_slides_may_12_2011.pdf
This work is licensed under a Creative Commons Attribution-NonCommercial- ShareAlike 3.0 United States License.
Christopher M. Bell