The third entry in my series on the 10 critical aspects of providing electronic health records to non-owned doctors is about modeling the costs of the project.
Based on the informatics literature, the initial implementation cost of an EHR for private practices averages between $40,000-$60,000 per provider and the cost of maintenance averages $5,000-10,000 per provider per year. Using these numbers, the total EHR implementation costs for our 300 non-owned doctors could be $12-$18 million and $1.5-$3 million per year. Of course, this includes total costs paid by the hospital and by the practices. To understand the economics of the project, we need to inventory all the costs included and who pays those costs. Stark safe harbors provide some guidance here, since Stark separates costs into those which can be shared with hospitals and those which must be paid by the providers themselves. Up to 85% of implementation costs excluding office hardware can be funded by the hospital. Hardware and most ongoing costs must be paid by the providers. We must also consider what costs the hospital should absorb for planning, legal and infrastructure to offer EHR services to non-owned doctors. These startup costs are nearly the same for 30 or 300 doctors, so they are not easily computed on a per provider basis.
Initial Costs
1. Startup costs to be funded by the hospital
Planning
Legal costs
Hosting Site hardware and operating system software
2. Practice implementation costs to be shared between the hospital and practices
Software licensing fees
Technical Deployment services and Workflow design services
Project Management costs
Training costs
Interface costs
Data conversion costs
3. Practice implementation costs to be funded entirely by the practice
Hardware local to the practice
Ongoing costs
1. Maintenance costs to be funded by the hospital
Hosting Site staffing and hardware lifecycle maintenance
2. Support costs to be shared per Stark
Help desk
Practice consulting support
3. Support costs to be funded entirely by the practice
Hardware service and support
Network connectivity
Of course, each of these categories and subcategories has its own detailed analysis. The "hydraulics" of our model must take into account the goals of the stakeholders - the hospital has a fixed capital budget and wants to connect as many doctors as possible. Doctors want as much subsidy as possible. Given the hospital contribution of x million, and a doctor's ability to pay of y thousand, we need to compute the subsidy level and number of doctors included in the rollout. To help with this decision we're dividing our budgets for all the categories above into fixed startup costs and marginal costs to add 100 doctors. We're also categorizing all costs as subsidizable or non-subsidizable.
Over the next 90 days, we'll do our best to achieve economies of scale, negotiate appropriate vendor pricing, and document acceptable service levels. Our Governance committees will review the final pricing to ensure we've achieved a balance of hospital costs, practice costs, and service. We'll also refine our cost models by documenting all the costs we experience in our pilots this Spring.
Our internal staff and external collaborators are doing a remarkable job documenting the costs. We'll know soon if it is possible to use the capital budgets that the hospital has available to create an EHR product at a price that clinicians are willing to pay for.
Saturday, February 9, 2008
Friday, February 8, 2008
Always Look on the Bright Side
Every day as a CIO, I inevitably receive unpleasant emails. I truly wish I could receive emails like
"The network and the servers have been running flawlessly for the past year. Congratulations on zero downtime"
but alas, no one is likely to send such an email.
The CIO has the challenge of delivering flawless operational performance while also managing constant change. It's a bit like changing the wings on a 747 while in flight.
I have an appropriate budget which is prioritized by excellent governance committees, and a yearly operating plan that is only occasionally interrupted by the "Tyranny of the Urgent" due to compliance, quality, or strategic opportunity mandates, but I still receive daily complaints such as:
"The Spam filters are too lax since I still receive some junk mail, but by the way, you need to let my eBay transactions through"
"My brother in law will offer me an Owuga 3000 desktop computer at a cheaper price, why are you using Dell and Lenovo hardware?"
"I need to surf pornography sites as part of an NIH funded research study and you should not restrict my academic freedom"
"My application, although not funded and not reviewed by any governance process, is your highest priority"
"I did not tell you that we needed network, telephones, desktops, and new applications by next week but now it's your emergency. I'm headed out to my vacation, let me know how it goes."
To all such complaints, a kneejerk response might be:
"Your bad planning does not constitute an emergency on my part"
or
"Every project is function of funding, scope, and time. You've provided no funding, so your project will either have zero scope or take infinite time"
but the CIO needs to respond
"Thanks so much for your thoughtful email. There is a process to evaluate your request and I will personally supervise your request during that process. Your peers and the clinical leadership of the entire organization will evaluate your request based on
Return on Investment
Quality/Compliance
Staff/Patient/Clinician impact
Strategic importance"
Every time I have responded to angry email with emotion I have regretted it. Although it may feel good to respond to a negative email with a venomous answer, emotion is never appropriate. I tell my staff that if they ever feel emotion while writing an email, "save as draft". Get someone else to review the response first. Send it after a day of rest.
Rather than judge the quality of every day based on the negative email I receive, I ask about our trajectory. Have we moved forward on our yearly and five year plan? Has today had 10 good things and only 5 bad things? Do I have my health, my family, and my reputation?
No matter how bad the week, the answer to all of these questions is always yes. Our trajectory is always positive.
With a positive trajectory in mind, a non-emotional response to every issue is easier. If a CIO ever uses profanity, a raised voice, or escalation to the CEO, the CIO diminishes himself/herself.
You can always recover from a bad day, but you cannot always recover from a bad email. Just ask Neal Patterson.
Thus, keep a stiff upper lip, have a thick skin, and run each day based on your trajectory not the position of your ego. And remember, "save as draft."
"The network and the servers have been running flawlessly for the past year. Congratulations on zero downtime"
but alas, no one is likely to send such an email.
The CIO has the challenge of delivering flawless operational performance while also managing constant change. It's a bit like changing the wings on a 747 while in flight.
I have an appropriate budget which is prioritized by excellent governance committees, and a yearly operating plan that is only occasionally interrupted by the "Tyranny of the Urgent" due to compliance, quality, or strategic opportunity mandates, but I still receive daily complaints such as:
"The Spam filters are too lax since I still receive some junk mail, but by the way, you need to let my eBay transactions through"
"My brother in law will offer me an Owuga 3000 desktop computer at a cheaper price, why are you using Dell and Lenovo hardware?"
"I need to surf pornography sites as part of an NIH funded research study and you should not restrict my academic freedom"
"My application, although not funded and not reviewed by any governance process, is your highest priority"
"I did not tell you that we needed network, telephones, desktops, and new applications by next week but now it's your emergency. I'm headed out to my vacation, let me know how it goes."
To all such complaints, a kneejerk response might be:
"Your bad planning does not constitute an emergency on my part"
or
"Every project is function of funding, scope, and time. You've provided no funding, so your project will either have zero scope or take infinite time"
but the CIO needs to respond
"Thanks so much for your thoughtful email. There is a process to evaluate your request and I will personally supervise your request during that process. Your peers and the clinical leadership of the entire organization will evaluate your request based on
Return on Investment
Quality/Compliance
Staff/Patient/Clinician impact
Strategic importance"
Every time I have responded to angry email with emotion I have regretted it. Although it may feel good to respond to a negative email with a venomous answer, emotion is never appropriate. I tell my staff that if they ever feel emotion while writing an email, "save as draft". Get someone else to review the response first. Send it after a day of rest.
Rather than judge the quality of every day based on the negative email I receive, I ask about our trajectory. Have we moved forward on our yearly and five year plan? Has today had 10 good things and only 5 bad things? Do I have my health, my family, and my reputation?
No matter how bad the week, the answer to all of these questions is always yes. Our trajectory is always positive.
With a positive trajectory in mind, a non-emotional response to every issue is easier. If a CIO ever uses profanity, a raised voice, or escalation to the CEO, the CIO diminishes himself/herself.
You can always recover from a bad day, but you cannot always recover from a bad email. Just ask Neal Patterson.
Thus, keep a stiff upper lip, have a thick skin, and run each day based on your trajectory not the position of your ego. And remember, "save as draft."
Wednesday, February 6, 2008
Cool Technology of the Week
As I travel around the world, I stay connected via WiFi, EVDO, EDGE, Broadband, and dialup. I'm often roaming from place to place on low speed networks, switching from WiFi to EDGE, and having to close all applications, VPN sessions, and even reboot as I travel to ensure robust application functionality.
The Cool Technology of the Week is Netmotion's Mobility XE Mobile VPN.
What is a mobile VPN? It's a VPN solution engineered to deal with the reality of wireless networks such as wireless security, coverage gaps and performance.
The technology consists of a server behind the firewall in the DMZ of your data center and a small laptop client application.
Whenever you login remotely, the Mobility XE server establishes a virtual IP address for your VPN session and persists this session for as long as you need it. With a persistent session, applications believe your IP is constant even if you switch networks, lose signal or hibernate your laptop. Mobility XE's InterNetwork Roaming is tightly integrated with network persistence, application session persistence and single sign-on authentication so that users do not lose application sessions or have to re-login when they traverse networks, go in and out of network range, or suspend and resume their devices.
It also works across VLANs on an intranet, so a mobile computer on wheels can connect to applications anywhere in the hospital without requiring a reboot or new login.
Additionally, the Mobility product comes with the ability to specify granular policies associated by system, application, user, or network address range. This provides the ability to do quality of service or restrict certain applications to a given address space. For example we can restrict high bandwidth applications from running while on WiFi in a clinical area but when moving into an office area allow the applications as there would be no clinical impact.
In the past at BIDMC, we implemented GRE tunneling and Wireless LAN Solution Engine (WLSE) components to enable roaming, but these are complex and have significant management overhead. A mobile VPN provides a more robust roaming experience while simplifying network architecture and administration. That's why it's the cool technology of the week.
The Cool Technology of the Week is Netmotion's Mobility XE Mobile VPN.
What is a mobile VPN? It's a VPN solution engineered to deal with the reality of wireless networks such as wireless security, coverage gaps and performance.
The technology consists of a server behind the firewall in the DMZ of your data center and a small laptop client application.
Whenever you login remotely, the Mobility XE server establishes a virtual IP address for your VPN session and persists this session for as long as you need it. With a persistent session, applications believe your IP is constant even if you switch networks, lose signal or hibernate your laptop. Mobility XE's InterNetwork Roaming is tightly integrated with network persistence, application session persistence and single sign-on authentication so that users do not lose application sessions or have to re-login when they traverse networks, go in and out of network range, or suspend and resume their devices.
It also works across VLANs on an intranet, so a mobile computer on wheels can connect to applications anywhere in the hospital without requiring a reboot or new login.
Additionally, the Mobility product comes with the ability to specify granular policies associated by system, application, user, or network address range. This provides the ability to do quality of service or restrict certain applications to a given address space. For example we can restrict high bandwidth applications from running while on WiFi in a clinical area but when moving into an office area allow the applications as there would be no clinical impact.
In the past at BIDMC, we implemented GRE tunneling and Wireless LAN Solution Engine (WLSE) components to enable roaming, but these are complex and have significant management overhead. A mobile VPN provides a more robust roaming experience while simplifying network architecture and administration. That's why it's the cool technology of the week.
Web Content Management Systems
In a previous post, I lamented that I had not rapidly adopted Web 2.0 for all my enterprises, making everyone an author, editor or publisher.
To help accelerate our Web 2.0 efforts, my web teams investigated Web Content Management Systems (CMS) which offer an integrated suite of page creation, wiki, blog, forum, and other distributed publishing tools.We evaluated offerings from Microsoft, Ektron, SiteCore, Documentum and others. The end result of our evaluation was to use SiteCore for content management in combination with free Microsoft Windows SharePoint Services 3.0 tools.
Our requirements for a CMS were Integration with our existing .NET/SQL Server 2005 web applications and SOAP services written in other platforms
Our plan is to convert our existing external websites to this new platform and gain a consistent navigation paradigm, enhanced search capability and common look/feel to every page. The most important aspect of this project is a new governance model which will distribute content authoring and maintenance to every department, overseen by project managers in Corporate Communications. As we change the governance model, we'll also be able to delete our outdated content which has made searching our 10,000 page website less than perfect.
I'm a strong advocate of a web content management strategy based on a distributed authoring model, driven by a workflow engine, with robust processes to ensure only accurate/updated content is available to internal and external search engines.
My experience is that most patients use Google to find content on the web rather than navigate a website, so doing a complete reorganization of our content into a database-backed authoring system that is easily spidered by Google will really help our patients find the information they are looking for.
At the same time we're implementing this wholesale revision of our external site, we're also revising our internal site to include collaboration tools, group calendaring, wikis, blogs, and customization. Using a combination of SiteCore and Microsoft's Windows SharePoint Services 3.0 tools, we hope to offer our internal stakeholders a much richer experience that supports departmental information management including Web 2.0 community interaction.
2008 will be the year of Web 2.0 for all my organizations and commercial Content Management Systems will help.
To help accelerate our Web 2.0 efforts, my web teams investigated Web Content Management Systems (CMS) which offer an integrated suite of page creation, wiki, blog, forum, and other distributed publishing tools.We evaluated offerings from Microsoft, Ektron, SiteCore, Documentum and others. The end result of our evaluation was to use SiteCore for content management in combination with free Microsoft Windows SharePoint Services 3.0 tools.
Our requirements for a CMS were
- A distributed publishing model which enables delegated content management by every person in the organization, with review by an editor before it is published to the public.
- Development, staging and production platforms which enable us to rigorously test our websites before publishing.
- Support for our home built single signon application that works via AJAX with any web form based authentication
- A robust "what you see is what you get editor" to support narrative text, graphic design, and multimedia
- A very easy to use authoring and publishing system with an intuitive user interface that does not require training
- User configurable business rules as to who can author, edit and publish as well as a workflow that supports lifecycle management of content
- A truly thin client approach that works on every browser and every operating system
- An architecture that enables our web sites to be clustered within a data center and replicated across multiple data centers for disaster recovery
- Authentication via our LDAP/Active Directory systems
Our plan is to convert our existing external websites to this new platform and gain a consistent navigation paradigm, enhanced search capability and common look/feel to every page. The most important aspect of this project is a new governance model which will distribute content authoring and maintenance to every department, overseen by project managers in Corporate Communications. As we change the governance model, we'll also be able to delete our outdated content which has made searching our 10,000 page website less than perfect.
I'm a strong advocate of a web content management strategy based on a distributed authoring model, driven by a workflow engine, with robust processes to ensure only accurate/updated content is available to internal and external search engines.
My experience is that most patients use Google to find content on the web rather than navigate a website, so doing a complete reorganization of our content into a database-backed authoring system that is easily spidered by Google will really help our patients find the information they are looking for.
At the same time we're implementing this wholesale revision of our external site, we're also revising our internal site to include collaboration tools, group calendaring, wikis, blogs, and customization. Using a combination of SiteCore and Microsoft's Windows SharePoint Services 3.0 tools, we hope to offer our internal stakeholders a much richer experience that supports departmental information management including Web 2.0 community interaction.
2008 will be the year of Web 2.0 for all my organizations and commercial Content Management Systems will help.
Monday, February 4, 2008
My Top 10 rules for Schedule triage
In previous posts, I've described my approach to email triage.
Here's my approach to triage of my daily schedule.
My meetings are typically scheduled from 7a to 6p, followed by dinner with my family until 8p, followed by email, reading and writing until 1am. My assistant and I schedule each day using the following rules:
1. Leave 50% of the schedule available for the events of each day - in a complex organization, many operational issues arise each day that are easier to resolve 'just in time' than via meetings scheduled a week later. I try to reserve 50% of my time for real time response to strategic issues, ad hoc meetings, phone calls, and opportunities, doing today's work today.
2. Manage vendor relationships - I receive a hundred requests for vendor meetings each day. My assistant triages these. My approach to vendors is that I select a few close vendor partners through exhaustive research and then really cultivate those relationships. If my selected vendor partners need me to alpha test products, speak to their staff about our needs, or comment on their strategy, I'm available to do so. If new vendors cold call me, I cannot take their calls, although I will review their products if they email me information to read asynchronously. My message to new vendors is that I'll contact them when I'm ready to discuss their products based on my review of electronic briefing materials.
3. Evaluate the impact factor - Every day I receive numerous requests to speak, travel and write. I evaluate the impact factor of each of these requests. How many people will I reach? Based on the audience, what positive change might result? Will there be an opportunity to discuss issues with detractors? As I've said in previous posts, I embrace debate and controversy, since resolving conflict can have great impact.
4. Serve those who serve you - In the course of my jobs at HMS, CareGroup, NEHEN, MA-Share and HITSP I depend upon hundreds of people. These people often work long hours, endure inconvenient travel, and sacrifice their personal time to work on projects I lead. I do whatever I can to support them whenever they ask me to speak, attend specialty society meetings, or write articles.
5. Leverage travel - Travel is miserable today. Each year, I fly 400,000 miles and I leverage every minute of that travel. I try to cluster many meetings, speaking engagements, and events around each trip. If I'm on the West Coast, I group all my San Francisco, Los Angeles, and San Diego meetings together into a 2 day cluster.
6. Use the interstitial time - Each day is filled with gaps between meetings, walking from place to place, and driving. I use this time as much as possible by filling it with hallway conversations, wireless email, and calls from the hands free bluetooth microphone in my Prius.
7. Keep focused on the important issues - The tyranny of the urgent creates distractions every day, but I stay focused on our yearly operating plan and 5 year plan. When I look at each week's schedule on Sunday night, I make sure that all the important issues are pre-scheduled into my week.
8. Debrief after every day - At the end of every day, I review my important issues list and review the progress and next steps on each issue. By doing this, I minimize the number of forgotten followups and dropped balls.
9. Respond to each email each day - I do not know the answer to every question that I'm asked via email, but I respond to each one with a description of the process I've initiated to get an accurate answer. This ensures that every person who emails me knows that I've acknowledged their question, even if an answer may take a few days to determine.
10. Never be the rate limiting step - In my schedule there is always time to resolve open issues, settle a political conflict, or answer an operational question. I close every day with an empty desk, an empty voice mailbox and an empty email queue. This enables all my staff to be as efficient and productive as possible since they are not waiting for me.
These 10 triage rules work most of the time to keep my schedule sane and stakeholders happy. Of course there are times when travel cannot be clustered or there are more meetings and urgent issues than hours in a day, but on average, my day is well balanced.
Here's my approach to triage of my daily schedule.
My meetings are typically scheduled from 7a to 6p, followed by dinner with my family until 8p, followed by email, reading and writing until 1am. My assistant and I schedule each day using the following rules:
1. Leave 50% of the schedule available for the events of each day - in a complex organization, many operational issues arise each day that are easier to resolve 'just in time' than via meetings scheduled a week later. I try to reserve 50% of my time for real time response to strategic issues, ad hoc meetings, phone calls, and opportunities, doing today's work today.
2. Manage vendor relationships - I receive a hundred requests for vendor meetings each day. My assistant triages these. My approach to vendors is that I select a few close vendor partners through exhaustive research and then really cultivate those relationships. If my selected vendor partners need me to alpha test products, speak to their staff about our needs, or comment on their strategy, I'm available to do so. If new vendors cold call me, I cannot take their calls, although I will review their products if they email me information to read asynchronously. My message to new vendors is that I'll contact them when I'm ready to discuss their products based on my review of electronic briefing materials.
3. Evaluate the impact factor - Every day I receive numerous requests to speak, travel and write. I evaluate the impact factor of each of these requests. How many people will I reach? Based on the audience, what positive change might result? Will there be an opportunity to discuss issues with detractors? As I've said in previous posts, I embrace debate and controversy, since resolving conflict can have great impact.
4. Serve those who serve you - In the course of my jobs at HMS, CareGroup, NEHEN, MA-Share and HITSP I depend upon hundreds of people. These people often work long hours, endure inconvenient travel, and sacrifice their personal time to work on projects I lead. I do whatever I can to support them whenever they ask me to speak, attend specialty society meetings, or write articles.
5. Leverage travel - Travel is miserable today. Each year, I fly 400,000 miles and I leverage every minute of that travel. I try to cluster many meetings, speaking engagements, and events around each trip. If I'm on the West Coast, I group all my San Francisco, Los Angeles, and San Diego meetings together into a 2 day cluster.
6. Use the interstitial time - Each day is filled with gaps between meetings, walking from place to place, and driving. I use this time as much as possible by filling it with hallway conversations, wireless email, and calls from the hands free bluetooth microphone in my Prius.
7. Keep focused on the important issues - The tyranny of the urgent creates distractions every day, but I stay focused on our yearly operating plan and 5 year plan. When I look at each week's schedule on Sunday night, I make sure that all the important issues are pre-scheduled into my week.
8. Debrief after every day - At the end of every day, I review my important issues list and review the progress and next steps on each issue. By doing this, I minimize the number of forgotten followups and dropped balls.
9. Respond to each email each day - I do not know the answer to every question that I'm asked via email, but I respond to each one with a description of the process I've initiated to get an accurate answer. This ensures that every person who emails me knows that I've acknowledged their question, even if an answer may take a few days to determine.
10. Never be the rate limiting step - In my schedule there is always time to resolve open issues, settle a political conflict, or answer an operational question. I close every day with an empty desk, an empty voice mailbox and an empty email queue. This enables all my staff to be as efficient and productive as possible since they are not waiting for me.
These 10 triage rules work most of the time to keep my schedule sane and stakeholders happy. Of course there are times when travel cannot be clustered or there are more meetings and urgent issues than hours in a day, but on average, my day is well balanced.
Electronic Records for Non-Owned Doctors - Governance
As promised last week, I will blog each week about the 10 critical aspects of our project to provide a hosted electronic health record solution for non-owned clinicians, one of the most challenging projects facing hospitals nationwide. This week's entry describes our project governance.
The needs of many stakeholders must be balanced to ensure the success of this project. The hospital wants to support as many clinicians as possible using its capital budgets most efficiently. Community clinicians want to minimize the financial and operational impact of the project on their practice. IT staff must manage their hospital-based projects and infrastructure while expanding their scope to new offsite locations.
Governance is critical to establish priorities, align stakeholders, and set expectations. To support this project we created two governance committees - a steering committee and an advisory committee.
The steering committee is comprised of senior executives from the hospital and physicians' organization, since it is truly a joint effort of Beth Israel Deaconess Medical Center (BIDMC) and the Beth Israel Deaconess Physicians' Organization (BIDPO). BIDMC representatives include the CFO, the CIO, the SVP of Network Development and the IT project manager. Physicians' organization members include the President, the Executive Director, and the Chief Medical Officer of BIDPO. This committee provides oversight of legal agreements, financial expenditures, project scope, timelines, and resources. It is co-chared by the CIO and Executive Director of BIDPO, who jointly sign off on all expenditures. The BIDMC and BIDPO boards provide additional oversight of the committee chairs.
The advisory committee is comprised of prospective community physician users of the electronic health record system. Since our community network is comprised of 300 non-owned Boston-based physicians, clinicians in the western suburbs and clinicians in the southern part of the state, we have representatives of each group sitting on the committee. The committee focuses on making the project really work for the practices, but also to meet the needs of the physician organization's clinically integrated network model. The role of the committee is to review our "model" office templates, help us prioritize the implementation order of practices, and make recommendations on policies. As with every project, we use our standard project management tools including a charter for each committee.
Since this project is so challenging and requires a precise blend of economics, information technology and politics, the governance committees are the place to ask permission, beg forgiveness, and communicate progress on every milestone. This is especially true to the complex cost model which shares expenditures equally between the hospital and physician's organization for implementation, subsidizing private clinician costs to the extent we are able based on Stark safe harbors. As you'll see in next week's EHR blog entry, the costs are diverse and deciding who pays/how much they pay cannot be done alone by IT, the hospital, or the physicians. It's truly a role for transparent, multi-disciplinary governance committees.
The needs of many stakeholders must be balanced to ensure the success of this project. The hospital wants to support as many clinicians as possible using its capital budgets most efficiently. Community clinicians want to minimize the financial and operational impact of the project on their practice. IT staff must manage their hospital-based projects and infrastructure while expanding their scope to new offsite locations.
Governance is critical to establish priorities, align stakeholders, and set expectations. To support this project we created two governance committees - a steering committee and an advisory committee.
The steering committee is comprised of senior executives from the hospital and physicians' organization, since it is truly a joint effort of Beth Israel Deaconess Medical Center (BIDMC) and the Beth Israel Deaconess Physicians' Organization (BIDPO). BIDMC representatives include the CFO, the CIO, the SVP of Network Development and the IT project manager. Physicians' organization members include the President, the Executive Director, and the Chief Medical Officer of BIDPO. This committee provides oversight of legal agreements, financial expenditures, project scope, timelines, and resources. It is co-chared by the CIO and Executive Director of BIDPO, who jointly sign off on all expenditures. The BIDMC and BIDPO boards provide additional oversight of the committee chairs.
The advisory committee is comprised of prospective community physician users of the electronic health record system. Since our community network is comprised of 300 non-owned Boston-based physicians, clinicians in the western suburbs and clinicians in the southern part of the state, we have representatives of each group sitting on the committee. The committee focuses on making the project really work for the practices, but also to meet the needs of the physician organization's clinically integrated network model. The role of the committee is to review our "model" office templates, help us prioritize the implementation order of practices, and make recommendations on policies. As with every project, we use our standard project management tools including a charter for each committee.
Since this project is so challenging and requires a precise blend of economics, information technology and politics, the governance committees are the place to ask permission, beg forgiveness, and communicate progress on every milestone. This is especially true to the complex cost model which shares expenditures equally between the hospital and physician's organization for implementation, subsidizing private clinician costs to the extent we are able based on Stark safe harbors. As you'll see in next week's EHR blog entry, the costs are diverse and deciding who pays/how much they pay cannot be done alone by IT, the hospital, or the physicians. It's truly a role for transparent, multi-disciplinary governance committees.
Managing Consulting Engagements
In previous blogs, I've mentioned the importance of project management. Every IT project, no matter how large or small, needs an assigned single point of contact for the IT department who can resolve day to day project issues and orchestrate communication. As I've said, not every project needs a Gantt chart and I'm dubious about the value of centralized project management offices for IT departments, but assigning an IT project manager and using a set of standardized project management tools are very important prerequisites for successful projects.
Consulting engagements need to be managed using the very same approach. All consulting projects need an IT project manager, a steering committee, and a project charter which documents the reason the consultants have been hired. For very politically challenging consulting engagements, the CIO can serve as the catalyst to start the project, but I do not recommend that the CIO serve as the IT project manager. The level of detail required to manage consultants requires more dedicated time than most CIOs have each day.
Here's the structured approach I recommend to manage consultants
1. Scope - All the stakeholders involved in the consulting engagement must agree on an unambigious scope for the project. The steering committee for the engagement should meet and agree on this scope before the consultants are engaged. This scope should be described in the project charter along with the governance that will be used to escalate questions about scope. Only by actively managing scope can consulting costs be controlled.
2. Deliverables - The result of a consulting engagement should be clearly described deliverables such as a finalized software product selection, a thoroughly researched whitepaper, or a comprehensive policy. The entire consulting engagement should be managed toward the production of these deliverables including interim review of drafts as often as possible. Mid course corrections of interim deliverables are always easier than a wholesale revision at the end of the process.
3. Interview Plan - Consultants, no matter how well intentioned, are disruptive to the day to day work of an organization since they need to meet with many stakeholders on an aggressive schedule to gather the information they need for their deliverables. The project manager overseeing the consulting engagement should work closely with the consultants to create a draft interview plan. This interview plan should specify the person, their role, and the questions to be answered.
4. Inform Superiors - The steering committee of the consulting engagement needs to review the draft interview plan, concur with the interview choices and ensure the managers of the interviewees are informed that the interviews will be scheduled. Typically, the project manager can send an email on behalf of the steering committee to the managers of the interviewees, so that all concerned realize the importance of the engagement.
5. Inform Interviewees - The managers of the interviewees should inform them of the purpose of the interviews and the need to schedule meetings with the consultants promptly. Urgent scheduling minimizes the cost of consultant time. The reason I prefer the direct managers to notify the interviewees is that most employees are reluctant to speak with consultants promptly unless they are told by their managers that they they can defer their other work to make time available for the consultants. Circulating a draft list of questions to each interviewee ahead of time is always helpful.
6. Conduct interviews - The interviews should be grouped by physical location to minimize consultant travel time. There are pros and cons to onsite verses phone interviews. Onsite interviews build a sense of team and establish relationships between the consultants and key stakeholders. However, onsite interviews generally require travel and hotel expense. Phone interviews are often easier to schedule and execute. Generally, we schedule the first consultant meetings with key stakeholders onsite and then followup meetings by phone.
7. Weekly deliverable check in - Every week, the steering committee (or an executive subset of the steering committee) should meet by phone to discuss the progress of the engagement and the status of deliverables. These weekly meetings are essential to rapidly resolve project roadblocks and clear up any misunderstandings.
8. Daily communication as needed - the IT Project Manager should be available to all stakeholders by email and phone to respond to daily issues as they arise. Interviews may need to be rescheduled, consultants may step on political landmines requiring escalation, and logistical details may need clarification.
9. Draft deliverable review - the entire steering committee should meet in person at a midpoint in the consulting engagement to review all the draft deliverable work and make recommendations about the final format, content, and timing of the deliverables, ensuring they align with the agreed upon scope.
10. Final communication of the deliverables and next steps - Once the deliverables are completed and reviewed by the committee, they should be broadly communicated to all the stakeholders involved in the engagement. Each interviewee will be more likely to participate in future engagements if they see the results of their input and understand next steps. After each consulting engagement, I summarize the key points from the deliverables so that everyone in the organization learns from the work and understands what we received for our money.
As a final note, I want to re-emphasize that consultants create a lot of work for internal staff, including those who manage the consultants and those who provide the documents requested during interviews. If anyone believes that consultants can simply parachute into an organization, do their work without disrupting operations, then depart, they have not been on the receiving end of a consulting engagement!
Consulting engagements need to be managed using the very same approach. All consulting projects need an IT project manager, a steering committee, and a project charter which documents the reason the consultants have been hired. For very politically challenging consulting engagements, the CIO can serve as the catalyst to start the project, but I do not recommend that the CIO serve as the IT project manager. The level of detail required to manage consultants requires more dedicated time than most CIOs have each day.
Here's the structured approach I recommend to manage consultants
1. Scope - All the stakeholders involved in the consulting engagement must agree on an unambigious scope for the project. The steering committee for the engagement should meet and agree on this scope before the consultants are engaged. This scope should be described in the project charter along with the governance that will be used to escalate questions about scope. Only by actively managing scope can consulting costs be controlled.
2. Deliverables - The result of a consulting engagement should be clearly described deliverables such as a finalized software product selection, a thoroughly researched whitepaper, or a comprehensive policy. The entire consulting engagement should be managed toward the production of these deliverables including interim review of drafts as often as possible. Mid course corrections of interim deliverables are always easier than a wholesale revision at the end of the process.
3. Interview Plan - Consultants, no matter how well intentioned, are disruptive to the day to day work of an organization since they need to meet with many stakeholders on an aggressive schedule to gather the information they need for their deliverables. The project manager overseeing the consulting engagement should work closely with the consultants to create a draft interview plan. This interview plan should specify the person, their role, and the questions to be answered.
4. Inform Superiors - The steering committee of the consulting engagement needs to review the draft interview plan, concur with the interview choices and ensure the managers of the interviewees are informed that the interviews will be scheduled. Typically, the project manager can send an email on behalf of the steering committee to the managers of the interviewees, so that all concerned realize the importance of the engagement.
5. Inform Interviewees - The managers of the interviewees should inform them of the purpose of the interviews and the need to schedule meetings with the consultants promptly. Urgent scheduling minimizes the cost of consultant time. The reason I prefer the direct managers to notify the interviewees is that most employees are reluctant to speak with consultants promptly unless they are told by their managers that they they can defer their other work to make time available for the consultants. Circulating a draft list of questions to each interviewee ahead of time is always helpful.
6. Conduct interviews - The interviews should be grouped by physical location to minimize consultant travel time. There are pros and cons to onsite verses phone interviews. Onsite interviews build a sense of team and establish relationships between the consultants and key stakeholders. However, onsite interviews generally require travel and hotel expense. Phone interviews are often easier to schedule and execute. Generally, we schedule the first consultant meetings with key stakeholders onsite and then followup meetings by phone.
7. Weekly deliverable check in - Every week, the steering committee (or an executive subset of the steering committee) should meet by phone to discuss the progress of the engagement and the status of deliverables. These weekly meetings are essential to rapidly resolve project roadblocks and clear up any misunderstandings.
8. Daily communication as needed - the IT Project Manager should be available to all stakeholders by email and phone to respond to daily issues as they arise. Interviews may need to be rescheduled, consultants may step on political landmines requiring escalation, and logistical details may need clarification.
9. Draft deliverable review - the entire steering committee should meet in person at a midpoint in the consulting engagement to review all the draft deliverable work and make recommendations about the final format, content, and timing of the deliverables, ensuring they align with the agreed upon scope.
10. Final communication of the deliverables and next steps - Once the deliverables are completed and reviewed by the committee, they should be broadly communicated to all the stakeholders involved in the engagement. Each interviewee will be more likely to participate in future engagements if they see the results of their input and understand next steps. After each consulting engagement, I summarize the key points from the deliverables so that everyone in the organization learns from the work and understands what we received for our money.
As a final note, I want to re-emphasize that consultants create a lot of work for internal staff, including those who manage the consultants and those who provide the documents requested during interviews. If anyone believes that consultants can simply parachute into an organization, do their work without disrupting operations, then depart, they have not been on the receiving end of a consulting engagement!
Subscribe to:
Posts (Atom)
