Implementation of an EHR: Focus on VistA

1
Implementation of an EHR Focus on VistA
Claudine D. Beron, PMP June 26, 2007

• Claudine D. Beron, PMP
• January 7, 2006

2
Agenda

• Need for an EHR
• Implementation Lessons Learned
• VistA Implementations
• Project Management PMI Methodology
• Project Life Cycle
• Project Process Areas
• Project Management for VistA
• Use Case on VistA

3
Need for an EHR

• 10 to 15 of the nation's doctors outside of the
  military and the Department of Veterans Affairs
  are using EHRs
• 33 of surveyed hospitals reported having PACS
  installed
• 10 of surveyed hospitals have CPOE systems
  installed
• 62 of US hospitals state that IT investment was
  a top priority
• 2004 HIMSS Analytics database of 4000 hospitals
  surveyed and Commonwealth Fund International
  Health Policy Survey (2003).

4
Reasons to Implement an EHR

• Enhance the quality of patient care
• Decrease and avoid medical errors - could save at
  least 44,000 and as many as 98,000 lives in the
  U.S. per year1
• Increase the profitability of the practice or
  facility - could yield a net value of 77.8
  billion per year once fully implemented
  throughout the U.S.2
• Reduce costs
• Increase revenue
• Improve the proper coding of patient encounters
  - defensible coding
• Provide backup documentation for
• Insurance company claims inquiries
• Malpractice allegations
• Comply with HIPAA
• Facilitate decision support, clinical trials,
  and medical research

5
EHR Implementation Lessons Learned
6
Key to Implementation of an EHR
EHR implementation entails more than installing
electronic tools-it's an opportunity to transform
the entire organization. To use technology to
improve patient safety and care efficiency,
examine the assumptions that underlie quality
care and consider which elements to maintain or
improve.
7
Lessons Learned

• Both vendors and providers have commented that a
  large number of implementation failures exist in
  the industry typically as a result of poor vendor
  support and training. These failures impact the
  adoption rate of IT in the healthcare arena
  including EHR adoption.
• reluctance of some of the doctors in a practice
  to use the HER
• insufficient support and training
• Perceived no return on investment or improvements
  in quality of life
• unrealistic expectations

8
Sample Implementation Road Map
9
VistA
VISTA INFORMATION SYSTEM
VISTA SOFTWARE PACKAGES
ACCOUNTS RECEIVABLE
VOLUNTARY SERVICE
REHAB MEDICINE
LIBRARY
MEDICAL
RECORDS
NURSING
TRACKING
ADMISSION DISCHARGE TRANSFER
VistA IMAGING
INTEGRATED DATABASE
RADIOLOGY
PERSONS
PATIENT FUNDS
BLOOD BANK
PROBLEM LIST
PATIENTS
DRUGS
RPC BROKER
SOCIAL WORK
MAILMAN
LABORATORY
MENTAL HEALTH
COMPUTERIZED PATIENT RECORD SYSTEM (CPRS)
DEVICE
TASK MANAGER
WARDS
KERNEL
MANAGER
LAB RESULTS
DENTAL
ENGINEERING
USER
MENU MANAGER
SECURITY
SURGERY
VA FILEMAN
HEALTH SUMMARY
ONCOLOGY
BAR CODE MEDICATION ADMINISTRATION
INVENTORY
PRESCRIPTIONS
DIETETICS
INPATIENT PHARMACY
IMAGES
MEDICINE
TEXT INTEGRATION UTILITIES (TIU)
WOMENS HEALTH
OUTPATIENT PHARMACY
INTEGRATED FUNDS CONTROL ACCOUNTING PROCUREMENT
MEDICAL CARE COST RECOVERY

• Sites of Care
• Clinics
• Hospitals
• Nursing Homes
• Domiciliary
• Home/Workplace

SCHED-ULING
CONSULTS / RESULT TRACKING
AUTHORIZATION SUBSCRIPTION UTILITY (ASU)
CLINICAL REMINDERS
CLINICAL PATIENT RECORD
10
VistA Implementation
11
VistA Implementations in the US

• Specific Examples include
• National Deployments
• 1. Department of Veterans Affairs, (VistA)1007
  sites-CONUS/OCONUS
• 2. Department of Defense, (AHLTA) 105 sites
  CONUS/OCONUS
• 3. Indian Health Services, (RPMS) 600 sites
• Single or Multi-site Implementations
• 1. California Department of Corrections
• 2. California, Oroville, Oroville Hospital
• 3. District of Columbia Department of Health
  (Dimensions Intl.)
• 4. Hawaii - Clint Spencer Clinic
• 5. Hawaii - Physician Center at Mililani (island
  of Oahu, Hawaii)
• 6. Hawaii, University of Hawaii Department of
  Geriatric Medicine (John A. Burns School of
  Medicine)
• 7. Oregon, Center for Women and the Family
• 8..Oklahoma Department of Veterans Affairs -8
  sites
• 9. Oklahoma, Midwest City, Midwest Nephrology
  Associates,
• 10. New Mexico, Albuquerque, Presbyterian Health
  Service,
• 11.Texas, Midland, Midland Memorial Hospital -9
  sites
• 12. Washington, Tacoma -Western State Hospital

12
VistA Implementations Worldwide

• Specific Examples include
• 1. American Samoa - Lyndon Baines Johnson
  Tropical Medical Center (LBJ TMC)
• 2. Colombia, Bogata, Government hospitals
• 3. Czech Republic , XORS Inc.
• 4. Egypt, Cairo, National Cancer Institute
• 5. Finland, Helsinski, Helsinki University
  Hospital
• 6. Finland, University Hospital of Kuopio,
• 7. Germany, University of Wurzburg, Germany
• 8. Germany, Berlin, German Heart Institute
• 9. Kenya, Nairobi, World Health Organization's
  Collaborating Center on AIDS and Sexually
  Transmitted Diseases, University of Nairobi
  School of Medicine
• 10. Mexico - Instituto Mexicano del Seguro Social
  (12 hospitals)
• 11. Uganda, Kampala, Nakasero Blood Bank
• 12. Nigeria, Obafemi Awolowo University Teaching
  Hospitals
• 13. Pakistan, SKM Cancer Hospital and Research
  Centre

13
Project Management PMI Methodology
14
PMI Methodology

• Project Management is not a cookie cutter skill
  set. Many project managers come from technical,
  clinical or other areas of expertise and are
  asked to manage projects for their organization
  without adequate training or skill development.
  The Project Management Institute (PMI) has
  developed a methodology and tools that are widely
  accepted throughout the world to help manage
  projects are all levels (500K to 100M) and
  industries (Construction to Health care). As
  every Project/Program Managers is unique, every
  project is, especially in health care.
• Tell me about the projects youve managed
  projects previously?

15
PMI Methodology
Project Management is accomplished through the
use of the core areas including initiating,
planning, executing, controlling, and closing and
represents over 44 processes. Each is
interdependent to the other and iterative in the
project life cycle. The PM process covers all
phases within the life cycle of any project. A
standard project will typically have the
following phases It is important to note
that many of the processes within project
management are iterative in nature. This is in
part due to the existence of and the necessity
for progressive elaboration in a project
throughout the project life cycle

• Plan
• Method/Approach
• Schedule
• Dependences
• Resources
• Cost
• Project Charter

• Initiate
• Sponsor
• Requirements
• Funding
• SOW
• Contract

• Execute
• Deliver
• Manage

• Control
• Cost
• Schedule
• Resources

• Close
• Cost
• Schedule
• Resources

16
Initiate Phase

• Initiate Phase
• This phase marks the beginning of the project or
  phase and formally authorizes the project. For a
  successful project, the objectives and
  requirements should be well defined at the start
  of the project.

Initiating Process Group Processes
A Guide to the Project Management Body of
Knowledge 3rd edition, PMI organization.
17
Plan Phase

• Plan Phase
• The Planning Process Group is considered the most
  important Process Group in project management.
  Time spent up front identifying the proper needs
  and structure for organizing and managing a
  project saves countless hours of confusion and
  rework during the Executing and Monitoring and
  Controlling Process Groups.
• Project planning defines project activities that
  will be performed, the products that will be
  produced, and describes how these activities will
  be accomplished and managed. Project planning
  defines each major task, estimates the time,
  resources and cost required, and provides a
  framework for management review and control.
• Planning involves identifying and documenting
  scope, tasks, schedules, cost, risk, quality, and
  staffing needs. This planning process
• Identifies specific work to be performed and the
  goals that define the project
• Provides documented estimates regarding schedule,
  resources and cost for planning, tracking, and
  controlling the project
• Obtains organizational commitments that are
  planned, documented, and agreed upon
• Continues the development and documentation of
  project alternatives, assumptions, and
  constraints
• Establishes a baseline of the plan from which the
  project will be managed.

18
Plan Phase
Planning Process Group Activities
A Guide to the Project Management Body of
Knowledge 3rd edition, PMI organization.
19
Execute Phase

• Execute Phase
• The Project Team and all necessary resources
  should be in place and ready to perform project
  activities. The Project Management Plan is
  completed and baselined by this time as well. The
  Project Teams and specifically the Project
  Managers focus now shifts from planning the
  project efforts to participating in, observing,
  and analyzing the work being done.
• The Executing is where the work activities of the
  Project Management Plan are executed, resulting
  in the completion of the project deliverables and
  achievement of the project objectives. This
  Process Group brings together all of the project
  management disciplines, resulting in a product or
  service that will meet the project deliverable
  requirements and the customers need. In this
  Process Group, elements completed in the Planning
  Process Group are implemented, time is expended,
  and money is spent.
• This Process Group requires the Project Manager
  and Project Team to
• Conduct, coordinate and manage the ongoing work
  activities
• Perform quality assurance activities continuously
  to ensure project objectives are being met or
  achieved
• Monitor identified risks for triggering events
  and implement containment or contingency
  strategies as necessary
• Distribute information to project stakeholders
• Manage change.
• In short, it means coordinating and managing the
  project resources while executing the Project
  Management Plan, performing the planned project
  activities, and ensuring they are completed
  efficiently.

20
Execute Phase
Procurement
Executing Process Group Processes
A Guide to the Project Management Body of
Knowledge 3rd edition, PMI organization.
21
Execute

• During an EHR implementation, staff from nearly
  every department is affected. The project
  managers key role is to coordinate the different
  program units and develop the infrastructure
  required to plan for, carry out and monitor the
  EHR implementation. The project plan is vital as
  it details the timing and sequence of the
  implementation, as well as identify areas in
  which the workflow may require redesign. All
  project management activities are documented
  using standard templates and updated regularly.

22
Execute Change Management

• The implementation of an EHR system creates
  significant organizational change. It is an
  intense process, because providers, nurses and
  staff are being asked to do their work in a new
  way. Often change engenders reactions, such as
  fear, resistance, even anger, so planned change
  management is essential to the success of the
  implementation project. Experience has shown that
  the most successful implementations demonstrate
  three key change management characteristics
  top-down support for change well-managed teams
  that share the implementation tasks and support
  for new system end users by providing them
  additional time to learn the system while not
  being swamped with patient appointments.

23
Control Phase

• Control Phase
• Project performance must be monitored and
  measured regularly to identify variances from the
  project plan. Occasionally, current projects of
  the on-line era, also demand a change in an
  objective or a deliverable. Hence the methodology
  is equipped with a flexible yet well-defined
  process to control and manage the changes being
  requested to the project scope and objectives,
  and allows revisiting of the above phases anytime
  during the project life cycle.
• Some of the main processes that can occur during
  this phase are
• Scope Change Control
• Risk Monitoring and control
• Cost control
• Performance Reporting

24
Control Phase
Monitoring and Controlling Process Group Processes
A Guide to the Project Management Body of
Knowledge 3rd edition, PMI organization.
25
Close Phase

• Close Phase
• The last major Process Group of a projects life
  cycle is the project Closing Process Group.
  Project closeout is performed after all defined
  project objectives have been met and the customer
  has formally accepted the projects deliverables
  and end product or, in some instances, when a
  project has been cancelled or terminated early.
  Project closeout is fairly routine, but it is an
  important process. By properly completing the
  project closeout, organizations can benefit from
  lessons learned and information compiled at
  closure.

Closing Process Group Processes
26
Dynamic of a Project
Organization Budget Limits
Organization Commitment
Stakeholder Management
Change Management
Budget Cycle
Internal Politics
Configuration Management
Communication Management
Manage a Project
Obtaining the Right Skill Sets
External Politics
Control
Initiate
Plan
Execute
Close
Subcontractor Management
Quality Assurance
Stages
Knowledge Management
Risk/Issue Management
Expectation Setting
Capturing Information
Resource Management
Solution Functionality
27
Key Considerations

• There are three key considerations that are most
  important to build a successful project
• Deliver to contract requirements
• setting expectations with the customer and
  ensuring that they understand what they will
  receive. A successful project is not one that
  delivers to customer requirements.
• Manage within Schedule
• building a detailed enough work plan is essential
  to managing to milestones and schedule.
• Manage within Budget
• keeping close control on hours by the team is
  crucial as well as other ODCs that must be paid
  for to complete contract requirements.

28
VistA Implementation Methodology
29
PMI Project Life Cycle
Project Management is accomplished through the
use of the core areas including initiating,
planning, executing, controlling, and closing and
represents over 44 processes. Each is
interdependent to the other and iterative in the
project life cycle. The PM process covers all
phases within the life cycle of any project. A
standard project will typically have the
following phases It is important to note
that many of the processes within project
management are iterative in nature. This is in
part due to the existence of and the necessity
for progressive elaboration in a project
throughout the project life cycle

• Initiate
• Sponsor
• Requirements
• Funding
• SOW
• Contract

• Plan
• Method/Approach
• Schedule
• Dependences
• Resources
• Cost
• Project Charter

• Execute
• Deliver
• Manage

• Control
• Cost
• Schedule
• Resources

• Close
• Cost
• Schedule
• Resources

30
VistA Project Life Cycle
Project Management for VistA is accomplished
through the use of the core areas including
initiating, planning, executing, controlling, and
closing and represents over 44 processes from
PMI.
Initiate
Plan
Close
Execute/Control

• Assess
• Environment
• Needs
• Standard Operating Procedures
• Benefits
• Resources Strain
• Budget

• Accept
• Identify Owners
• Identify Stakeholders
• Future Budgeting
• Complexity

• Deploy
• Hardware
• Software
• Configure to Environment

• Educate
• Compare EHRs
• Build Business Case
• Develop ROI
• Understand Functionality

• Train
• Ongoing maintenance
• Clinical Staff

• Support
• Ongoing maintenance
• Updates/Patches
• Additional modules

31
VISTA Implementation Methodology
The interdependent architecture of VistA dictates
a sequential implementation approach. Each
project plan must first begin with the
implementation of the PIMS to bring registration,
bed control and scheduling on-line. Other
departments such as laboratory, radiology and
pharmacy may then be automated. Through this
process a fully functioning CPRS with physician
order entry may be achieved. PMI must be
founded upon these requirements to maximize
staffing efficiency. The systematic automation of
hospital processes will also act to reduce the
disruptive effects of large scale efforts.

• Foundation
• Fileman
• Kernel
• Mailman

• Core
• Lab
• Radiology
• Pharmacy

• Standard
• CPRS
• Dietetics
• Social Work

• Extended
• Imaging
• BCMA

32
Implementation Key Criteria

• Executive Sponsorship
• Involvement of key stake holders right from the
  beginning
• Focus on Change Management not just technology
• Well defined project plan with milestones and
  critical path
• Accountability and process to make timely
  decisions
• Risk mitigation cant eliminate risks have to
  manage it
• Defining the vendor performance and monitoring it
• Assignment of requisite resources
• Managing the expectation setting
• Communication, communication, communication
• It is a marathon not a sprint

33
Project Managementfor VistA
34
VistA Methodology
Project Management for VistA is accomplished
through the use of the core areas including
initiating, planning, executing, controlling, and
closing and represents over 44 processes from
PMI.
Initiate
Plan
Close
Execute/Control

• Assess
• Environment
• Needs
• Standard Operating Procedures
• Benefits
• Resources Strain
• Budget

• Accept
• Identify Owners
• Identify Stakeholders
• Future Budgeting
• Complexity

• Deploy
• Hardware
• Software
• Configure to Environment

• Educate
• Compare EHRs
• Build Business Case
• Develop ROI
• Understand Functionality

• Train
• Ongoing maintenance
• Clinical Staff

• Support
• Ongoing maintenance
• Updates/Patches
• Additional modules

35
VistA Case Study

• Holly Cross is a New York-based system that
  provides more than 1 million acute care visits
  each year through two major hospitals with over
  500 inpatient beds and 38,210 annual discharges,
  and nine clinics. In the spring of 2006, senior
  administrators proposed implementation of
  electronic health records (EHR) to its medical
  staff.
• The executive team viewed EHR usage as integral
  to the organization's strategic business plan,
  citing the need to support an infrastructure of
  care reorganization, refined quality measures and
  reporting processes, and evidence-based practice
  for management of chronic disease. Stakeholders
  would measure the implementation's success by how
  well EHR technology improved patient safety and
  care delivery, such as retrieval of patient
  information and clinical documentation throughout
  the health network. The system has planned a
  budget of 5 million per year for the next 3
  years to implement an EHR and the first
  implementation must be completed in the next 6
  months. Discuss what needs to be discussed and
  agreed upon for this to happen.

36
VISTA Project Management

• Initiate
• Educate Your Organization on VistA/EHR
• Identify Owners Stakeholders and get buy-in
• Identify Subject Matter Experts in each area
  considered
• Understand the Environment Today (high level
  only)
• Description of organization by Bed,
  Acute/LongTerm/etc and types of patients
• Services provided today (note difference if more
  than one environment)
• Legacy Systems in place? Which ones
• Interfaces (HL-7 ver 2.0?, NCPDP, etc)
• Quality of Data, if any
• of Clinical and IT Staff Outside of the Project
  Team
• Skills that will be needed
• Develop Business Case that include preliminary
  scope requirements
• Understand Budget Cycle and Politics
• Understand Procurement Process (if vendors are
  used)

37
VISTA Project Management

• Plan
• On Site Assessment of the Environment's)
• Detail questions/interviews for each clinical
  area to implemented VistA modules based on
  preliminary scope
• Develop Gap analysis of actual systems and
  resources
• Build Draft Project Plan/WBS Schedule
• Confirm Scope requirements
• Prepare Budget and Resource needs assessment
• Develop Request for Proposal (RFP) for Vendor
  Services, if applicable
• Evaluate Proposals for winning bid with lead
  clinical staff included
• Validate start date and terms and conditions
• Select Vendor and approve start date
• Update Schedule and Project Plan/WBS
• Verify Staffing by Organization and Assignments
• Verify Training by Organization and Assignment
• Order Hardware/Software for Test/Development and
  Production Site(s)
• Start up meeting to bring all stakeholders
  together

38
VISTA Project Management

• Execute
• Build Test/Development System
• Include staff responsible for ongoing maintenance
  for training
• Document System (Build Guide, Configuration
  Guide)
• Test System prior to implementing VistA
• Load VistA and Configure Modules mapped to
  current services
• Foundation (Foundation, FileMan, HL7, Kernel, all
  mandatory)
• Basic (Lab, Pharmacy, Scheduling, etc)
• Standard (CPRS, Problem List, etc)
• Extended (Hepatitis C, Medical Clinical Services,
  etc)
• Include staff identified as subject matter
  experts to validate configuration of modules and
  training
• Test System prior to ghosting to Production
  System
• Provide 1st Round training while system is
  Test/Development
• Verify configuration and usability by end users
  at Pilot Site
• Deploy Pilot Site (Production Site)
• Train SMEs and End-Users at Pilot Site
• Evaluation of course material essential
• Obtain Site Completion Sign off by owner
• Deploy Disaster Recovery Site

39
VISTA Project Management

• Control
• Scope Change Control
• Validate throughout the project that scope is
  aligned with deliverables
• Changes documented in Change Request with owners
  signature
• Risk Monitoring and Control
• Develop Risk and Issue logs
• Meet on weekly basis with team/owners to document
  and discuss mitigation strategies
• Engage now owners if mitigation strategies arent
  working dont wait
• Cost control
• Review and document with team hours allotted and
  scope of work to be done
• Manage weekly/bi-weekly/monthly timesheet
  reporting
• Manage subcontractors, if any to their contracts
• Manage weekly/bi-weekly/monthly timesheet
  reporting
• Manage ODCs and document any discrepancies in
  estimated vs actual cost
• Report to owner when 75 of project is complete
• Performance Reporting
• Provide monthly reports on financials and
  milestone/deliverables completed based on
  schedule and project plan.

40
VISTA Project Management

• Close
• Complete closeout of any contracts
  subcontractors/product vendors
• Document licensing and warrantee for systems
• Sign off of customer acceptance
• Attach site completion sign offs
• Closeout of any financial matters
• Prepare final reports
• Conducting a project review with all stakeholders
• Documenting lessons learned
• Completing, collecting and archiving project
  records
• Celebrate!

41
VISTA Implementation Matrix
Process Benefits Risks if not completed Deliverable
Scope Plan Clearly define the roadmap for the project Milestone achievements meet financial parameters and expectations The plan becomes the basis for ongoing progress assessment Roles and responsibilities are clearly delineated Accountability for Executive Team in driving project success and achieving the organizational objectives and vision Project failure with lost revenue and margin Confusion, frustration and lack of buy-in for all staff and project team Inefficient allocation of project resources Project Plan Software Communication Plan Risk Assessment Resource Plan Testing Plan Technical Plan
Design Stakeholder engagement Early awareness of gaps between desired and actual functionality Increased end user resistance Potential adverse financial impact of redesign Inability for end users to perform job Greater risk of medical error and sentinel event Solutions Design Session Signoff Reporting Specifications Risk Management Assessments
Configure Prototype Functioning system Milestones and benefits are not realized Proof Of Concept Demo Functioning Application
Develop Test Determination if code functions as designed per client requirements Increased confidence in the system Production readiness which drives the transition and preparation activities Delayed conversion with much higher costs Potential non-functioning, error prone system If duplicate effort and workarounds are required, staff overtime, additional staffing and/or agency expense are incurred Test Plan Code Issue Identification/Resolution Performance Issue Identification/Resolution Completed System Interfaces Conversion Readiness Assessment
Implement Support Achievement of strategic vision Greater medical and clinical staff system acceptance Loss of capital investment and operational efficiency Decreased staff retention Loss of medical and clinical staff acceptance Functioning CPRS system For End Users Post-Conversion Assessment Plan
42
VISTA Implementation Matrix
Solutions Benefits Risks if not completed Deliverable
Change Assessment A quick but comprehensive assessment of the organization to determine its ability to absorb VistA based on financials, operational / clinical performance and project risks All staff will understand how their jobs will change by new processes IT Solutions may not be prioritized to focus on immediate gains. Project champions will not be identified, Efforts will not be aligned with goals Organizational productivity metrics will not be established in strategic planning Key SOPs will not be re-deigned Organizational Change Plan Infrastructure Assessment SOP Analysis Training Analysis Risk Assessment
Stakeholder Ownership Identify risks, barriers, and enablers of change Leadership alignment with localized sponsorship and change management network Ability to manage resistance/stakeholder buy-in Heightened resistance with lack of adoption for new processes, systems, roles/responsibilities Poor decision-making, rumor mills, buy-in less likely, lack of commitment from stakeholders, and nonaligned leadership Increased employee turnover Stakeholder Analysis Project Leadership And Champion Assessment
Communication Plan Delivery All impacted audiences are identified, informed, and engaged and connected with project team Increased buy-in from bottom-up Chaos during transition. Impacted audiences unaware of changes and their respective roles Communication Plan
Organization Design New job/role descriptions Effective and efficient utilization of resources Organization structure aligned with strategic planning and job design Lack of cross-functional coordination and misuse of resources, duplication of effort and unclear value chain Ambiguity related to roles job tasks Organization Chart Job Descriptions
End-User Training Staff and clinicians have skills to perform their roles responsibilities Define necessary materials for a successful training End-users gain confidence in their roles, and with new system Lost productivity, confusion, unsuccessful project with increased level of resistance End-users unable to perform their jobs Learning Assessments And Learning Plans Training Curriculum
Team Integration Significant collaboration during intense and chaotic project life-cycle All changes are well understood by myriad of stakeholders, project teams and leaders Lack of coordination and duplication of effort Poor team and organizational performance with low productivity / morale Team Development Plans
43
VISTA Implementation Matrix
Solutions Benefits Risks if not completed Deliverable
Technology Roadmap Technology solution consistent with care transformation goals Long term technology strategy mapped Address high risk of technology to project success Insufficient funds allocated to support the system Technology not sufficient to support care transformation Inability to plan for project adequately. Technology Workshop Integrated Project Plan Client Technology Roadmap
Access Strategy Align the the accessibility of solutions with the clients strategic plan Create remote access strategy Provider efficiency affected by inadequate device strategy Impedes buy in of system by physicians if can't access information remotely Network Assessment Design Documents Hardware Medium Assessment
Security Risk Assessment Understand authentication solutions that match business and industry requirements Violation of patient privacy (HIPAA) Difficulty of adding security if not built into solution May risk noncompliance with JCAHO standards Security Policy Risk Assessments
Performance/Capacity Management Performance methodology in place System performance is baselined Load is modeled Removes client need to try to create load manually Performance issues appear after go-live Poor understanding of VistA impact upon organizational effectiveness Reactive performance management driven by end-user impact Baseline Performance Results Desktop Assessment
Operational Readiness Proactive detection of events that could impact production Trend analysis that will provide capacity planning for managed components. Network (near future) event and trend / capacity management Central control and distribution of managed components Decreased client satisfaction due to undetected failure of manageable components Unable to proactively determine capacity or trend of managed components Reactive not proactive model of support. No central control of client issues Trend, event and escalation of events
44
VistA Reading

• Kalchugina, Townsend, Medical Records in the
  Greater Los Angeles State Veterans Home A Unique
  Opportunity to Improve Quality of Care
  http//repositories.cdlib.org/lewis/sr/student_rep
  ort_02/
• West OMahony, Contrasting Community Building
  in Sponsored and Community Founded Open Source
  Projects, Proceedings of the 38th Annual
  HawaiI, International Conference on System
  Sciences, Waikoloa, Hawaii, January 3-6, 2005.
  http//opensource.mit.edu/papers/westomahony.pdf
• Goldstein, Ponkshe, Maduro, Profile of
  Increasing Use of OSS in the Federal Government
  and Healthcare http//www.medicalalliances.com/do
  wnloads/files/Open_Source_Software-Government_and_
  Healthcare_White_Paper-Medical_Alliances_2.doc
• The Veterans Health Administration Quality,
  Value, Accountability, and Information as
  Transforming Strategies for Patient-Centered Care
  , The American Journal of Managed Care, November,
  2004. http//www1.va.gov/cprsdemo/docs/AJMCnovPrt2
  Perlin828to836.pdf
• Comparison of Quality of Care for Patients in the
  Veterans Health Administration and Patients in a
  National Sample , Annals of Internal Medicine,
  December, 2004. http//www1.va.gov/cprsdemo/docs/I
  nternal_Medicine_Article_on_VistA.pdf
• The Best Care Anywhere , Washington Monthly,
  January/February, 2005. http//www1.va.gov/cprsdem
  o/docs/Article_Washington_Monthly_Jan_Feb_2005.doc
  
• Brown, Lincoln, Groen, Kolodner, VistA US
  Department of Veterans Affairs National Scale
  HIS, International Journal of Medical
  Informatics. February 2003 http//www1.va.gov/cpr
  sdemo/docs/VistA_Int_Jrnl_Article.pdf
• Munnecke, Tom, Personal Health From Systems to
  Space, July 19, 2002
• Hanson, Susan P. "HIM Role in Bringing e-HIM to
  Small Practices." Journal of AHIMA 76, no.4
  (April 2005) 54-55,65. http//library.ahima.org/x
  pedio/groups/public/documents/ahima/pub_bok1_02642
  8.html

45
EHR Reading

• Terry, Ken, IT Implementation Why EHRs falter
  , April 7, 2006 http//www.memag.com/memag/artic
  le/articleDetail.jsp?id316528pageID1
• IT Executives Offer Advice for Adopting
  Electronic Records MAY 21, 2007
  http//emradvice.wordpress.com/tag/emr-failure/
• Planning, Early Support Keys to EMR Success,
  Execs Say, May 21, 2007 http//emradvice.wordpress
  .com/2007/05/21/planning-early-support-keys-to-emr
  -success-execs-say/
• Brief Report of the AAFPs EHR Pilot Project Key
  Learnings from Six Small Family Practices
  American Academy of Family Physicians Center for
  Health information Technology March 8, 2005
  http//www.centerforhit.org/PreBuilt/chit_pilotres
  ults.pdf
• Kenneth G. Adler, How to Successfully Navigate
  Your EHR Implementation , February 2007
  http//www.aafp.org/fpm/20070200/33howt.html
• Laurie Craven, RN, So, youre the project
  manager! http//www.doqit-tx.org/newsletter/DOQ-IT
  2002_07.htm

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PM Reading

1. A Guide to the Project Management Body of
   Knowledge,(2000 edition)
2. Effective Project Management, Chapter 6. Wysocki
   / Beck Jr. / Crane.
3. The New Project Management, Chapters 8, 12-13,
   Frame, J. Davidson, 1994
4. Earned Value Project Management, Second Edition,
   Chapter 5. Flemming and Koppleman
5. Project Management A Managerial Approach, pp.
   43-44. Meredith and Mantel
6. PMBOK (2000) QA, PMI, Scope Section
7. Ten Steps http//www.tenstep.com/
8. AllPM http//www.allpm.com/
9. C. William Ibbs, Young H. Kwak, Calculating
   Project Managements Return on Investment
   http//www.ce.berkeley.edu/pmroi/calculating-PMROI
   .pdf
10. PMBoulevard http//www.pmboulevard.com/

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VistA Links

• VistA-CPRS Demo - http//www1.va.gov/CPRSdemo/
• CMS - VistA Office EHR
• http//www.cms.hhs.gov/quality/pfqi.aspVista-Offi
  ce20EHR
• Indian Health - RPMS - http//www.ihs.gov/Cio/RPMS
  /index.cfm
• DoD - CHCS http//www.tricare.osd.mil/peo/citpo/pr
  ojects.htm
• Pacific Hui - http//www.pacifichui.org/
• WorldVistA - http//www.worldvista.org
• Hardharts.org - http//www.hardhats.org/
• Vista Software Alliance- http//www.vistasoftware.
  org

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Contacts

• Claudine Beron, PMP
• Accenture
• 703-947-3610
• 703-599-1203 cell
• claudine.d.beron_at_accenture.com

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