MedSys White Paper: Pre-Implementation Planning

Preparing For Success: Early Planning For Large Healthcare IT Projects

Introduction

Serious issues in large healthcare information technology  (HCIT) projects are never in short supply. Negative patient impacts, substantial revenue shortfalls, leadership turmoil: the consequences can be serious and prolonged. At the very least, they cost time, attention, and focus at moments when all three are in short supply.

But it’s not that nobody is trying to avoid trouble. In fact, there’s a large team of highly skilled individuals working to avoid just these issues. Nor, in most cases, is the issue one of basic competence or drive. The people working on these projects are often the most seasoned clinicians and managers in the organization, and they have a deep desire to make their organization better. Why, then, does it happen that the projects encounter so many problems, both during and after implementation?

As often than not, the problems arise from simple challenges in project management: fixing scope, handling unavoidable issues, and keeping on target for a successful go-live. And, in our experience, critical failures frequently happen early, in the pre-implementation planning that could have set the stage for success. Nor, to be frank, are these failures unpredictable. In fact, they often come down to a small set of seemingly obvious tasks that are ignored or neglected at the wrong moments.

Failure 1: Wasting the “early time”.

Approval for a new IT project, especially a very large one, is a prolonged and uncertain task. At the outset, those who see the need must create a case, establish a rough budget and timeline, and secure approval at every level. It takes months, and during that time the organization itself is often “frozen” – anticipating new changes but unwilling to plan for them.

In fact, though, this early phase is a tremendous opportunity. While resources (particularly budget) are often scarce, the “pause” at the start can be exploited to identify stakeholders, collect concerns and issues, and document the current state of the organization. This work is frequently done in any event, during technology selection or other decision-making phases. The degree to which these critical activities can be continued during the approval phase, and the degree to which they fold seamlessly into project planning are key drivers for the success of the overall effort.

Even more than that, the “early time” activities help to weld the project sponsorship and champions together. This is the exciting time in a project: broad horizons, uncertain staffing, unclear roles, but a shared sense of doing something transformative. To the extent that project management can unite that entrepreneurial moment with actual work to be done, the project will benefit hugely.

Failure 2: Not assessing current state.

Closely related to the “early time” task challenge is the paired risk of failing to assess the state of the organization prior to implementing the new system. We frequently hear “our systems are just a mess”, or “we’re throwing it all away”. So why would we want to wallow in an examination of the unsatisfactory present rather than looking to the bright future?

Unfortunately, IT implementations never happen in a vacuum. Few new hospitals are being built, and even fewer are built with an open selection of software. In the vast majority of cases, one technology suite is replacing another, or is replacing finely tuned paper processes that have existed for years. With that situation comes the simple fact that change management will be a primary task of the project. And change management requires a baseline.

Understanding the baseline state of the organization is a non-trivial task, arduous at best and unending at worst. The larger the organization, the more likely that there are areas of significant variability, dysfunction, or alternative practices. Not all variability is bad, and there is no one functional style that is the best, but differences add to the scope of the project. And missed scope that comes from missed current-state analysis is an incredibly common cause of project failure. A thorough current-state analysis is the best insurance possible against last-minute surprises.

Failure 3: Unclear or incomplete planning after contracting but prior to kickoff

When a project “kicks off” – when the team begins the organized activities that define, configure, and test the software prior to go-live – the project plan must be fully fleshed. MedSys Group has seen many projects struggle because the project plan was simply not completed.

Key documents – project charters, timelines, governance structures, budgets, staffing matrixes, and communications structures – should be done well and approved broadly. Decision-making templates need to be tested and evaluated, and processes for input need to be practiced. The pre-kickoff time is an excellent opportunity to set and practice meeting structures, risk management activities, and status reporting. While none of these replace actually doing the project work, practice and refinement in these areas will pay off many times over when the work is at hand.

Even more critically, these early activities help to educate and prepare the project team. When the building, testing, and training kick into high gear, there is a necessary time when teams work in parallel silos, counting on other teams to do the same. Management oversight helps to coordinate this work, of course, and planning helps, but the more that teams can review the work to be done and be comfortable with the overall plan before the heavy lifting starts, the less likely that the project will see unexpected discrepancies and delays.

Failure 4: Failure to establish effective governance

No large IT project proceeds without change. New scope, unexpected organizational change, new regulatory or financial requirements, staff turnover – all of these and more will happen in the months following kick-off. Consequential decisions will need to be made, and organizational buy-in to those decisions is critical.

The early planning for a project must include establishment of effective governance. Governance for a project must not only arrive at good decisions, but it must include methods to ensure that those decisions are effective, well-documented, and trusted. These things are not automatic.

Effective IT decision-making means that not only are the IT questions answered, but the decision is endorsed by the operational and clinical leaders who have the authority to enact the needed organizational change. That is, the people sitting at the table making the IT decisions need to be the people who will then tell their doctors, nurses, and staff to carry out the new plan. Critical failures of effective governance occur when technologists make (or are thought to make) decisions in a vacuum that either cannot or will not be supported operationally.

Closely coupled to this is the documentation of decisions. When a choice is made, particularly if it changes a previous stance, the documentation must clearly explain the decision. Communication must be broad and transparent so that the inevitable “chatter” about change can focus on facts, not rumors. Our experience is also that the more that the rationale for the decision is part of the overall documentation, the more likely it is that the decision will be well understood and carried out in the years that follow implementation.

The final area of danger in governance is trust. Every organization is different in its people and its politics. This inevitable fact of life means that every organization arrives at confidence in the decisions of its leaders differently. A governance plan for a major IT initiative must take into account these issues and match the decision-making style of the organization to the decision-making style of the project. Thoughtful planning of the committees, authorities, and executive scope will produce great dividends.

Failure 5: Failure to anticipate failure

In large healthcare IT projects, there is no perfect implementation. People make mistakes, technology turns out to be inadequate, and surprises are around every corner. The complexity and cost of these projects, not to mention their huge cost and tight timeframes, means that there will be failures – challenges that threaten the project. Project plans that ignore this reality turn small issues into large ones, and large ones into organizational legends.

Anticipating failure in the project plan means considering every step, understanding the risks involved, and building mitigations into the project structure. These can be as simple as ensuring adequate contingency dollars or as complex as requiring every key leader to have an “understudy” who can take over in the case of incapacity. Allowing for date flexibility, ensuring time after testing for fixes and updates, and ensuring that additional staff are available at key times are all measures that should be considered.

A final measure to consider in this area is to make a practice of documenting failures. Calling them “lessons learned” may reduce the sting, but the mistakes made and the information thus gleaned are crucial assets produced by well-run projects. Planning for this and ensuring its execution can create surprising value to an organization.

Conclusion:

Large HCIT implementations will have challenges. Recognizing this fact at the outset, and planning for the challenges as well as the successes, reduces costs, risks, and delays. The best people in the world – smart, caring, and highly educated – need structure and process to work at their peak. Proper planning sets the stage for success.

Alan Kravitz

Alan Kravitz, President, Co-founder and Chief Executive Officer, manages and oversees overall strategic leadership and operations, with emphasis on client relationships and sales initiatives, as well as executive participation in recruiting of the top talent in the industry. As the strategic leader for the organization, he is responsible for developing the organization strategic initiatives for expansion. With over eighteen years of Healthcare Information Technology experience, his relationships and knowledge served to establish MedSys as a leader in Healthcare IT Consulting.

His career in Healthcare IT began in 1994 when he founded CAP Associates, a nationwide Healthcare Information Technology recruiting firm. After several years of continued growth in EMR recruiting, in 1998 he expanded operations by founding Genesys Group, a technology focused solutions provider in staff augmentation, IT outsourcing and managed services. Using a developed model, he founded MedSys Group Consulting in 2008 to service the ever-growing needs to the healthcare technology market. Kravitz attributes the company success to the devoted work of the dedicated leadership team, as well as the principles under which the organization operates; Respect, Honesty, Trust, Commitment and Communication. “Our accomplishments are not defined or driven by just a few, but by realizing everyone’s combined contributions at all levels of the organization. Keeping it simple, doing business with the golden rule in mind, and focusing on client communication and service will fuel our continued success and growth.” Kravitz earned his Bachelor of Science degree in Business Administration with an emphasis in Management and Marketing from The University of Missouri. He currently resides in Frisco, Texas and is married with three children.

Nancy Ellefson

As Executive Vice President and Chief Financial Officer, Nancy Ellefson is responsible for the day-to-day workings of accounting, finance, human resources and information technology in addition to risk and cash management for the organization. In addition she implements and maintains systems, policies, and procedures that provide the necessary support for internal operations as well as field employees and contractors. Ellefson is also responsible for the overall financial well being of the company through financial planning and analysis of results.

Prior to joining MedSys, her 30 plus years of experience includes serving as CFO of Preferred Restaurant Services and APEX Restaurant Group, Vice President of Finance for Furr’s Restaurant Group and Pizza Inn, Controller for numerous public and privately held companies, as well as a financial analyst with two major healthcare systems, Barnes Hospital and Presbyterian Hospital of Dallas. Ellefson is a certified public accountant with four years of public accounting experience with Laventhol and Horwath in St. Louis, which had an extensive hospital practice.

Mark Embry

Mark Embry, Co-founder and EVP of Client Development, aids in the development of strategies for expansion of MedSys through joint ventures and other cooperation with Partner Organizations.

With over a decade of healthcare technology experience, he has forged strategic relationships with major healthcare IT vendors and partners across the EMR market. He has been instrumental in solidifying partnerships across the EMR market with companies such as Cerner Corporation, ACS, Healthcare, Epic Systems Corporation, Siemens Healthcare, and DELL Healthcare. His prior industry experience includes serving as a major account executive for TekSystems, one of the leading providers of IT solutions to the US market. Embry credits his success in business to the hiring of quality individuals who surround a committed leadership team. "Our goal is to empower our employees to create success by aligning the company's business goals with their individual goals. We believe that if we can inspire personal growth among our team members, business success will follow." Embry has a BA in Business Marketing from Baylor University. He currently resides in Frisco, Texas and is married with three children.

Luther Nussbaum

Luther Nussbaum serves at Chairman of the Audit and Compensation Committees. Nussbaum is active in operational improvement and developing the strategic road map for the Firm as a member of the Executive Committee. He previously served as Chairman of the Board from January 2013 until the close of 2014.Additionally, he serves as a mentor to the leadership team. With vast experience in healthcare, high tech and other industries, Nussbaum brings innovative ideas and the application of breakthrough solutions to this inspiring vision.

Nussbaum is the semi-retired Chairman and Chief Executive Officer of First Consulting Group. During his decade-long tenure at FCG, the company increased eightfold in size, expanded its service offerings from consulting and systems implementation to management services and software products and led the industry in utilizing worldwide resources in India and Vietnam to achieve a very low cost, high quality project-delivery model. In addition to his managerial roles, Nussbaum has served as an active and creative Board member, Advisory Board member or mentor with a dozen companies. He has hired or mentored more than forty executives who are now Chief Executive Officers of a broad array of companies. As an executive, Nussbaum was a VP, President, COO and CEO of a handful of high technology and healthcare services companies. Mr. Nussbaum received his B.A. from Rhodes College where he was elected into Phi Beta Kappa and his M.B.A. from Stanford University where he was named an Arjay Miller Scholar.

Grant Campfield

Grant's experience in healthcare ranges from managing implementation teams within hospital and ambulatory settings to working with government PMO offices on strategy and approach. His background with IDN (Integrated Delivery Network) clients and the federal government has provided him with an extensive understanding of the contracting process through to post-live optimization. Campfield is now focusing most of his time on relationships and delivery within the federal and state government space.

Campfield is a graduate of Kansas State University with a Bachelor's Degree in Business Marketing. He currently resides in the Dallas area with his wife Markie.

Jeff Jensen

MedSys Group today announced the designation of Jeff Jensen as Client Relationship Executive. In his role, Mr. Jensen will be responsible for managing new and current client relationships across the healthcare IT spectrum. Mr. Jensen began his career in healthcare in 1994 in physician recruiting, becoming Director of Physician Recruiting for the Central Region. Additionally, he provided leadership in the pharmaceutical and medical equipment industries, representing Johnson & Johnson and other companies in the operating room. After finishing his MBA from the Cox School of Business at SMU he left the operating room and joined the healthcare IT world focusing on the Dallas market. Jeff spent the next 13 years partnering with healthcare systems to help them upgrade their network and physical infrastructure, business software, EHR systems, service line software, operating room equipment configurations, imaging devices, mobile platforms, telehealth platforms, cloud migration and also worked on collaborative projects with marketing and technology to help develop and enhance the digital patient experience. Mr. Jensen’s passion and focus continues to be around healthcare technology, and the impact that it has on improving patient care.

We’re extremely excited about the addition of Jeff to our team. Jeff’s dozen-plus years of experience in this industry as an innovator of how technology is delivered has us confident in his abilities to handle the current, and aid in the growth, we’re encountering today.    His unflappable focus on delivering genuine value to our clients is what has attracted our firm the most with regard to our decision. I’ve no doubt our current and future clients will benefit from Jeff’s business acumen”, noted Alan Kravitz, MedSys Group CEO.

“Healthcare has always been about taking care of the patient. As healthcare evolves and relies more on technology to keep patients healthy, MedSys group is poised to advise hospital systems in their exploration of using patient improvement metrics for revenue generation instead of just fee for service models. Helping hospital systems treat patients as customers with service options they already have in other industries is exciting to me.” Said Mr. Jensen

Patricia Drew

Patty Drew, Senior Strategist, began her career in healthcare in 1997 as a Registration Clerk at Eastern Maine Medical Center (EMMC) in Maine. At that time, EMMC was opening a centralized scheduling call center and she was transferred to that department as a Scheduling Clerk. She quickly moved to the healthcare IT side as a database analyst working with the Cerner Registration and Scheduling applications. Her career progressed as she became IT Director for Access Management and Physician Services at Eastern Maine Healthcare System (EMHS) responsible for the implementation and maintenance of the Cerner Registration, Scheduling and Ambulatory applications as well as the GE Centricity EMR for physician practices within EMHS as well as various physician practices across the state. Patty joined MedSys in 2012 as a Senior Consultant and since has been promoted to Senior Strategist and serves as a Revenue Cycle Implementation Specialist focusing on Registration and Scheduling.

Patty received her Associates Degree in Medical Office Administration from Husson University.

Aaron Spratt

Aaron’s experience in healthcare ranges from managing EHR implementations in both the ambulatory and hospital setting, directing the operations of a hospital IT department, managing physician practice operations, overseeing Meaningful Use compliance in multiple organizations and managing Joint Commission compliance for a Midwestern healthcare system. He particularly enjoys working with physicians and other clinicians to optimize the use of EHR systems to help meet strategic goals.

He obtained his Bachelor of Science in Business Administration and a Masters in Business Administration from Southeast Missouri State University.  He is a member of the Medical Group Management Association (MGMA) and a Certified Medical Practice Executive (CMPE) through the American College of Medical Practice Executives, MGMA’s certification and fellowship body.

Romona Rivere

Romona Rivere is responsible for nationwide recruiting support and training and development of recruiting personnel. She has over 20 years of experience in the Healthcare Industry. Romona is a member of the strategy management team which is comprised of the core leadership of the organization.

She has worked as a healthcare recruiter for over fifteen years and has been an integral part of the MedSys Group recruiting team for the past nine years. Her many notable accomplishments include consistent achievement of top recruiter and top employee of year awards. Romona is well known throughout the industry as one of the best recruiters in healthcare information technology and enjoys the highest approval rating from her MedSys Group consultants. Romona resides in Dallas, TX.