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please read all notes below question and answer below question

Before this assignment, please make sure to review the notes from this week's "Notes" folder.

In at least 500 of your own words, describe the components of the IT project proposal and steps to improve IT project value realization.Why is this important for you to know in your prospective career field?

notes

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Assessing and Achieving Value in Health Care Information Systems

Definition of IT

-enable value

Differing objectives for projects

Scoring objectives

Reducing the budget

Common proposal problems

Ensuring the delivery of value

The IT value challenge

Digital maturity

Tangible (measurable value) & intangible (difficult to measure value)

- Tangible: Increases in revenue, fewer errors, reduction in turnover, etc.

- Intangible: Improved decision-making, communication, compliance, etc.

Significant

Variable across organizations

- Organizations may focus on different objectives

Diverse across IT proposals

Diverse value in a single investment

Different analyses for different objectives (see next slide)

IT ObjectivesNational Research Council (NRC)1. Infrastructure- Enables other investments or applications to be implemented and deliver desired capabilities (e.g., data communication networks, workstations, clinical data repositories)

2. Mandated

- May be necessary in order to comply with initiatives of accrediting bodies

3. Cost reduction

IT Objectives

4. Specific new products and services- Involves consumer utilization, competitor response, and impact on related businesses

5. Quality improvement

- E.g., reduce waiting times, improve the ability of physicians to locate information, improve treatment outcomes, reduce errors in treatment

6. Major strategic initiative

- Intended to significantly change the competitive position of the organization or redefine the core nature of the enterprise

Classes of Investment1. Transformation

- Effect a significant improvement in overall performance

- Change the nature of the organization

2. Renewal

- Upgrade core IT infrastructure and applications

- Reduce the costs

- Improve the quality of IT services

3. Process improvement

- Improve the operations of a specific business entity

4. Experiments

- Evaluate new information technologies and test new types of applications

Sources of Value Information

Conferences

Industry publications

Industry research organizations (e.g., Gartner and the Advisory Board)

Consultants

Vendors

Formal financial analysis

- Net present value

- Internal rate of return

Formal Financial Analysis

Net present value

- Calculated by subtracting the initial investment from the future cash flows that result from the investment

Formal financial analysis

- Discount rate at which the present value of an investment's future cash flow Select key proposal areas for scoring

Assign a score for each area & total the scores

- Range: 1 (minimal or no contribution) to 5 (significant contribution)

Benefits

- Forces leadership to discuss why team members assigned different scores

- Forces leadership to defend any decision not to fund a project with a high score or to fund one with a low score

Is it mandatory due to a regulation (e.g., a new Medicare rule)?

Can the project be put off until next year?

Does the IT staff have time to take on another project?

Does the user department have stable management?

Are the value proposition and resource estimate complete?

Is there a less expensive application or non-It approach?

Can the progress occur at a slower pace?

Common Proposal Problems

1. Fractions of effort

- Saving fractions of staff effort does not always lead to salary savings!

2. Reliance on complex behavior

- People do not always behave as we expect or want them to.

3. Unwarranted optimism

- Nothing will go wrong

- You're in control of all variables that might affect the project

- You know exactly what changes in work processes are needed and what system features must be present

- Everyone can give full time to the project

Common Proposal Problems

4. Shaky extrapolations

- Assuming that gains in the first year will continue during the remaining life of the project

5. Underestimating the effort

- Forgetting to account for the time users and managers devote to system design, developing workflow changes, and training

6. Fairy-tale savings

- Redeploying expenses instead of reducing the budget

7. Failing to account for post implementation costs

- Maintenance contacts, hardware upgrades, etc.

Ensuring Delivery of Value

Make sure the homework was done

Require formal project proposals

Increase accountability for investment results

- Business owner should defend the investment

- Project sponsors and business owners must understand the accountability for successful completion of the project

- Present projects in a forum that routinely reviews such requests

Manage the project well

Manage outcomes

Ensuring Delivery of Value

Conduct post-implementation audits

- Value is NOT automatically achieved because the implementation is over.

Celebrate value achievement

Leverage organizational governance

Shorten the deliverables cycle

Benchmark value

- Benchmark performance against the performance of peers

Communicate value

- Develop a communication plan for the 12 months ahead1. Infrastructure

- The core information technology that serves as the foundation for all applications

2. Transactional

- Supports the core operations processes

3. Informational

- Supports the decision making such as clinical decision support, quality measurement and analyses, market assessment, and budget performance

4. Strategic

- Critical to the furthering of an organization's strategy

The IT Value Challenge

Factors that hinder value return

- The overall strategy is wrong or its assessment of its competitive environment is inadequate

- The necessary IT applications and infrastructure are not defined appropriately

- The organization fails to identify all the investments and initiatives necessary to carry out its plans

- The organization fails to execute the IT plan well

- External factors (e.g., competitors' actions, customers' reactions, etc.)

The IT Value Challenge

The investment-performance relationship

- Spending more money on IT is no guarantee that the organization will be better off

- Factors other thank the appropriateness of the tool to the task also influence the relationship

The value of the overall investment

- Difficult to assess the value of its overall investments in IT

The IT Value Challenge

Progressive realization of IT value

- Requires innovation in business practices

- Economic value comes from incremental innovations rather than "big bang"initiatives

- The strategic impact comes from the cumulative effect of sustained initiatives to innovate business practices

Digital Maturity

Defined by CapGemini as

- Digital intensity: the extent to which the company had invested technology

-enabled initiatives to change how the company operates

- Transformation management intensity: the extent of the leadership capabilities necessary to drive digital transformation through the company

Transformation management intensity is more important than digital intensity.

Summary

Definition of IT

-enable value

Differing objectives for projects

- Infrastructure- Mandated

- Cost reduction

- Specific new products and services

- Quality improvement

- Major strategic initiative

Scoring objectives

Reducing the budget

Common proposal problems

- Fractions of effort

- Reliance on complex behavior

- Unwarranted optimism

- Shaky extrapolations

- Underestimating the effort

- Fairy-tale savings

- Failure to account for post

-implementation costs

Summary

Ensuring the delivery of value

- Make sure homework was done

- Require formal project proposals

- Increase accountability

- Manage the project well

- Manage outcomes

- Conduct post-implementation audits

- Celebrate value achievement

- Leverage organizational governance

- Shorten the deliverables cycle

- Benchmark value

- Communicate value

The IT value challenge

- How to measure?

- Progressive realization

Digital maturity

- Digital intensity

- Transformation management intensity

Building the EHR Implementation Team

Your electronic health record (EHR) implementation team, also known as the steering committee, can make or break the implementation process. Members of your EHR implementation team should possess:

• Differing perspectives on how the EHR will be used
• A wide array of skills and knowledge
• An ability and willingness to devote sufficient time to the EHR implementation process
• A consistently positive point of view toward the EHR implementation process

EHR Implementation Team

You should include the following EHR implementation team members on your EHR implementation team.

• • EHR Team Lead
  • EHR Implementation Manager
  • Physician Champion
  • Nurse Lead
  • Medical Assistant Lead
  • Scheduler Lead
  • Registration Staff Lead
  • Laboratory Staff Lead
  • Information Technology Lead
  • Billing Staff Lead
  • EHR Builder
  • Meaningful Use Lead
  • Workflow Redesign Lead
  • Super-User/Training Lead

EHR Implementation Team Tools

Depending on the size and type of your organization, your organization may assign employees to more than one role. You can use the Creating a Leadership Team for Successful EHR Implementation template to learn more about the different EHR implementation team roles and as a template to document important planning decisions.

Four Crucial Members of an EHR Implementation Team

Updated: 12th May 2017

When undertaking an EHR system change, there are many considerations to take into account. While most system implementations may require a dozen or more highly skilled professionals, here is a short-list of key members that are integral to seeing an implementation through to the end.

1. Project manager

The project manager (PM) is the quarterback of the EHR implementation team. This person should betechnically minded and have previous experience in implementing EHR. With many vendors to choose from, it is important for the PM to already have experience working on an EHR system from the same vendor. This is due to the differing platforms and nuances that are unique to each system.

A PM is responsible for the project's overall success, including hitting requirements and meeting deadlines for the role out of the new EHR system. Additionally, the Project Manager connects the different phases of the project to seamlessly work and communicate together. The planning, design, development, implementation, and testing phases must coordinate their effects to be successful and the PM is the point person in facilitating these processes.

2. Application analyst

Another critical member of an EHR implementation team is an application analyst. This person is essentially responsible for connecting the ideas and concepts that the facility wants in place with the development team. By gathering EHR requirements from internal IT teams, department leads, executives, and end-users, the application analyst will take this information and put it into technical form for the developers to take into a design stage.

Often, an application analyst will have a clinical background as either a registered nurse or a pharmacist. This is extremely helpful asanalysts need to understand the day-to-day clinical needs of each application.

3. Application developer

Once the requirements are formed to customize the EHR system, the application developer is tasked with the development portion of the project. This includes designing and implementing applications for specific departments as requested. For example, some EHR systems have applications specific to the Emergency Department, Inpatient Pharmacy, Radiology, Operating Room, Anesthesia, ICU, Nurse Triage, and several other departments.

This allows each departmental function to be customized by the developer to be more effective for the facility's end-users. This can include specific field information, dashboards, or other user interfaces that have been outlined by the Application Analyst.

4. Quality assurancetest engineer

After the Application developer has completed the EHR system installations, the testing phase can begin. At this stage, a quality assurance test engineer with expertise in the particular EHR system deployed will be required to come in and test the system from various viewpoints.

Much like the application analyst, a QA test engineer is often required to have a clinical background. Their expertise in hands-on clinical roles provides the knowledge of how daily operations work in a hospital setting. Testing and quality reviews can be performed for data security, proper functionality for each clinical department, performance review, and to verify the system can handle the total volume of users.

Learning Objectives

Discuss the process that a health care organization typically goes through inimplementing a HCIS.

Assess the organizational and behavioral factors that can affect systemacceptance and the use and strategies for managing change.

Develop a sample system implementation plan for a health care informationsystem project, including the types of individuals who should be involved.

Gain insight into many of the things that can go wrong during system implementations and strategies that health care managers can employ to alleviate potential problems.

Discuss the importance of training, technical support, infrastructure, and ongoing maintenance and evaluation of any HCIS project.

Outline

Establishing an implementation team

Activities of system implementation projects

Managing change

Organizational and behavioral factors

System support and evaluation

Implementation Team

Primary function is to plan, coordinate, budge, and manage all aspects of the new system implementation

Composition of team (should include some of the same people involved in selecting the system

- Project leader- System champion

- Key individuals from the areas that are the focus of the new system

- Vendor representatives

- IT professionals

Team Responsibilities

1. Cleary define the project scope and goals

2. Identify accountability for the successful completion of the project- Business sponsor- Business owner(s)- Project manager- IT manager

3. Establish and institute a project plan

Major Activities

Implementation Project

Note: The order of these activities should be determined by theorganization in accordance with its needs and resources- Workflow and process analysis

- System installation

- Staff training

- Conversion

- Communications

- Preparation for go-live date

- System downtime procedures

Workflow/Process Analysis

Identify ways to improve workflow, simply tasks, eliminated redundancy, improve quality, improve user satisfaction

Avoid simply automating outdated and inefficient processes

Gain initial buy-in by involving users during the redesign process

System Installation

Install hardware, software, and network infrastructure to support the new information system

Build necessary interfaces

IT staff play a crucial role in this phase

Pilot the system in a unit or area before rolling out enterprise-wide- Evaluate system effectiveness- Address issues/concerns, fix bugs- Apply lessons learned to other units

Staff Training

Train the trainer v. a pool of trainers

Timing is everything!- Just-in-time training- Ample opportunity to practice BEFORE the go-live

Update procedure manuals

Communicate who to contact if they have questions or concerns

Conversion

Convert the data from the old system to the new system

Clean the data before converting- Complete data- Accurate data- Current data

Run data through a series of validation checkpoints to ensure accuracyof conversion

Test, test, test!

Communications

Have an effective plan for communicating progress

- Aids members of the implementation team in communicating and coordinating their activities

- Identifies how progress is communicated to the key constituent groups

- Current data

The methods may be varied, but the message should be consistent and the information presented up-to-date and timely.

Preparation for Go-Live

Implementation team should ensure

- The system is ready through testing

- Staff members are trained

- Appropriate procedures are in place

- Disaster recover plans are in place

- IT staff in place to monitor and assess system problems/errors

System Downtime Procedures

Scheduled and unscheduled downtime exists

Downtime procedures should be communicated BEFORE go-live

Managing Change

Change must be led!

- Describe the vision

What the world will look like after the change?

How staff roles and work life will be different?

Why making this change is important?

- Language: use "should" instead of "must" ; "we" instead of "you" Staff are willing to rise to a challenge if they trust their leaders

- Act in the best interest of the staff/organization

- Listen and respond to concerns of the staff/organization

Managing Change

Provide incentives

- Intrinsic: excitement over the change; fear of what will happen

- Extrinsic: bonuses, a promotion, awards, etc.

Change must be planned!

- Tasks must be allotted resources

- Accountable staff for task performance must be determined

- When problems occur, iteration and adjustment is necessary

Behavioral Factors

1. Create an appropriate environment

- User expectations vary

- Clear and effective communication is key

2. Do not underestimate user resistance

- Understand the culture BEFORE you make the investment

- User acceptance occurs when users see or realize the value the HCISbrings to their work and the patients they serve

Behavioral Factors

Manage unintended consequences

- More work or new work- Workflow

- System demands

- Communication

- Emotions

- New kinds of errors

- Power shifts

- Dependence on the system

Organizational Factors

1. Allocate sufficient resources

- Adequate technical staff expertise

- Reliable and secure IT infrastructure

2. Provide adequate training

- Both BEFORE the go-live date and AFTER as the system is upgraded and changed

- Different training methods for different user groups1. Establish a strong relationship with the vendor

- Define expectations, resource needs, timelines

- Have open, honest, and candid conversations when problems arise or differences inexpectation occur

Support & Evaluation

Problems will be detected and changes will be needed

- IT staff should correct the problem or work with the vendor

- The vendor may detect glitches and develop upgrades or patches

Optimizing use of the system

- Additional training

- Revised workflows- Adding new features or functionality

- Using data from the system for quality improvement initiatives