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Coplan, S. & Masuda, D. (2011). Project management for healthcare information technology. Paper presented at PMI® Global Congress 2011—North America, Dallas, TX. Newtown Square, PA: Project Management Institute.

David Masuda, MD, MSc, Faculty, University of Washington

Synopsis

This white paper describes an effective methodology that integrates standards and best practices from project management, information technology management, and change management for a streamlined transition to digital medicine.

This article includes the Knowledge Areas for each management discipline, organized by the core project management Process Groups, Initiating, Planning, Executing, Monitoring and Controlling, and Closing. Examples from healthcare information technology projects illustrate how this integrated approach can lead to improved healthcare delivery.

The Challenge

The Health Information Technology for Economic and Clinical Health (HITECH) Act (U. s. Department of Health and Human Services, 2011) seeks to improve American healthcare delivery and patient care through an unprecedented investment in Health Information Technology (HIT).

Only 4% of physicians report having extensive, fully functional Electronic Health Records (EHR) systems due, in part, to:

· Resistance from physicians

· Loss of productivity

· Uncertainty about return on investment

· Inappropriate patient information disclosure (DesRoches, Campbell, Donelan, Ferris, Jha, Kaushal, et al., 2008, pp 50-60)

The United States plans to spend over US$18 billion on HIT in the next five years (Millard, 2010, p 2), yet:

· We consume 15% of our GDP in healthcare and receive what many would call second-class care (Goldman, McGlynn, 2005, p 3)

· A patient walking into a clinic or hospital has only a 55% chance of getting the right medical advice (Goldman, McGlynn, 2003, p 3)

Without improving HIT project success rates:

· The value of HIT diminishes

· Future HIT investment is at risk

· Ever-increasing demand on healthcare services will result in a greater healthcare crisis

The Solution

Unless we change how we perform HIT project management, we will not improve healthcare adequately. This requires a fundamental shift in how organizations manage HIT projects, as follows:

· Relying on the project management, IT management, and change management disciplines individually does not ensure project success

· Integrating all three increases the likelihood of project success

Exhibit 1 illustrates applying Project Management Institute's A Guide to the Project Management Body of Knowledge (PMBOK® Guide) (PMI, 2008) Process Group framework across the life cycle of a project to integrate the project management, IT management, and change management disciplines.

Exhibit 1 – PMBOK Process Groups

Exhibit 2 illustrates supplementing the existing PMBOK® Guide project management Knowledge Areas with:

· IT knowledge areas from the Institute of Electrical and Electronic Engineers’ A Guide to the Software Engineering Body of Knowledge (SWEBOK) (IEEE, 2004)

· Change management knowledge areas from organizational behavior and organizational development well-developed theories and practices

Exhibit 2 – Knowledge Areas

Exhibit 3 illustrates integrating these three disciplines into a single methodology

Exhibit 3 – Integrated Project Management

“Project management was an absolute critical aspect of our…implementation. Unless you have sufficient and tuned in project management for a large-scale clinical systems initiative, it's bound to fail. That's not just the management and technical components, obviously that's important and necessary. Change management, for example, includes user training, understanding user existing workflow, and how those workflows might change with the implementation. I think those aspects are equally if not more important than the project and technical aspects of the implementation”. (Coplan and Masuda, 2011, p 7)

Empowering HIT personnel with IPM skills helps improve patient care.

Exhibit 4 – IPM Shifts the Focus to Meeting Patient Needs

Changes in workflow, defined using IPM, engage the caregiver and patient in a dialogue, “strengthening the therapeutic alliance between the physician and patient and improving patient satisfaction” (O’Connor, Wennberg, France, et al., 2007, p 724).

Computerized Physician Order Entry (CPOE) [and Clinical Decision Support (CDS)] has the potential to significantly reduce hospital-wide mortality rates (Longhurst, Parast, Sandborg, et al., 2010, pp e1-e8).