From Planning to Reality: Operationalizing a New Health Care Information System

Prepared by Rebecca Enmark, MLIS

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Congratulations, it's a health care information system. You've slogged through what seems like interminable interviews, meetings, system demonstrations and site visits. Now you can really start getting down to making your organization more efficient. Wrong. You've already started. Three key tasks essential to the ultimate success of any new technology begin during vendor selection/system development.

By focusing upon three areas - each having specific development tasks and objectives - health care organizations will be positioned to optimize return on investment from their information systems.

Development Tasks & Objectives:

	Transition Management	Requirements Definition	Core Competency Development
In Vendor Selection / System Development…	• Transition planning, change management effort	• Define organizational requirement	• Deficiencies noted • "Stretch" goals delineated • Knowledge transfer goals put in place
In Contracting…	• Extent of necessary organizational transformation should become clear	• Translate requirements into clear and understandable milestones	• Project team skill balanced • Knowledge transfer incorporated as key component of plan
In System Implementation…	• Transition complete, change begins	• Milestones achieved • Requirements examined, redirected as necessary	• Organization develops key internal resources with critical system knowledge • Commit to ongoing competency development

Transition Management:

Much has been written about the health care industry's resistance to change. Often, it is not change itself that creates havoc, but the transitional period between the "old" and the "new." This transition actually begins during long-range planning, when the organization establishes a strategic direction and builds planning competencies. During vendor selection or system development, the transition broadens, impacting the organization in deeper ways. Simply in examining systems, the organization is considering the question - Is there a better way?

The bigger the impact of a system, the more critical it is to begin transition management efforts early. One IT Optimizers client, embarking on an electronic commerce technology project:

• Created a special steering committee composed of key management and end-users;
• Sponsored seminars and news "updates" to discuss the project, key changes and requirements;
• Involved entire affected departments in developing the "future state" processes to be implemented with the new technology;
• Established key organizational contacts to manage questions and problems throughout the duration of the planning-selection-contracting-implementation process.

It is important to remember, when considering the impact of a new system or technology, that "splash" effects can occur - a new laboratory system, for example, can have an impact upon physician workflow (creating lab orders, viewing/accessing lab results) or surgery scheduling (tests that must be conducted within a particular time frame pre/post-op). An effective transition management program considers all the changes that may come from the introduction of a new system/technology.

Requirements Definition

Understanding the key functionality required from a system/technology and prioritizing each functional need sets an organization down a focused path toward return on investment. After a vendor is selected, incorporating those gap (critical) items into the contract can act both to manage risk as well as to set clear expectations with the technology supplier. Many operational problems arise because expectations were either not set or were poorly communicated or documented.

During contracting, both groups - the health care organization and the system/technology supplier - begin the process of translating system potential and organizational needs into reality. During this process, it is imperative that language and expectations become as clearly articulated as possible. Contracting can be a somewhat tedious process, revolving around word choices, dates and dollar amounts, with both groups trying to protect themselves.

There are a number of important strategies to ensure that organizational requirements remain central to the process:

• Develop "milestones" that clearly tie vendor performance and service delivery to payment. Contracts should specifically indicate what portion of the total payment will be paid upon signature, upon delivery of functionality and/or upon successful use of the system in a production environment. Milestones can also be used to manage specific risks faced by the health care organization. An IT Optimizers client working with a small Internet services vendor successfully incorporated a monthly fee rebate for deadline overruns (if caused by the vendor). In that way, the organization had some protection should the project prove larger in scope than the vendor could manage.

• Insist on clarity during the negotiation process. During one recent engagement, the vendor in negotiations would return a revised contract after each session, without noting revisions. So instead of moving progressively from start to finish, our client was forced into a "start over" mode, verifying that previous agreements were still noted in the contract being proposed. Organizations should mandate that revised versions of proposed contracts clearly and specifically note changes. Standard word processing systems have revision tracking features; there is really no excuse not to use them.

• Don't rely on memory; use issue tracking tools. Even for larger contracts, issues tracking and prioritization can be logically tracked. Our standard tool looks like the one below. 

Contract Reference	Issue / Question	Recommended Resolution	Priority	Agreed Upon Resolution
P7 12 Notices	Contract does not explicitly allow notification via e-mail	Request modification	Low
P90 3.1 Responsibilities	"Use reasonable efforts to grant access to Customer's network only to third parties authorized in writing by customer."	Change to "Grant access to Customer's network only to third parties authorized in writing by customer."	Critical HIPAA-Related issue
P3 2.2 Taxes	Wording implies that vendor will pass through any tax penalties assessed for incorrect billing.	Delete "…and other assessments or charges levied or imposed by any governmental body or agency."	High

By articulating and deciding the importance of issues in advance of negotiation, organizations can focus upon those areas most important to their success.

Core Competency Development

Knowledge transfer is an ongoing challenge for every organization, especially when consultant or vendor staff is deeply involved in a project. Knowledge transfer is something very few organizations (provider, payer, consultant or vendor) do well. It should be a key goal from the beginning of any process, and knowledge transfer/competency development objectives should be documented and consistently measured.

Strategies in this area include:

• Examine the state of organizational competency early on in a selection process - where are there gaps? In which areas can existing skill sets be "stretched" even higher?

• Ensure that implementation teams are skill balanced (organizational, vendor and consultant), and that knowledge transfer into the organization is incorporated into the implementation process.

• Make skills measurement a regular part of completed implementation processes.

Setting clear priorities, examining critical resource, skill and functional requirements and managing entire processes rather than compartmentalized projects are all ways that health care organizations can effectively move from choosing a system or technology vendor to having an operational, effective system with supportive work processes and clear return on investment.

Rebecca Enmark provides technology research, planning, vendor evaluation and selection services. She can be reached at info@itoptimizers.com.

 

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