the path to paperless
Managing Your EMR Project
Good planning can overcome unexpected delays.

By Peter J. Polack, M.D., F.A.C.S.

Late last summer, our city of Ocala, located in the center of Florida, was directly hit by two of the four major hurricanes that made landfall. Due to a combination of lengthy power outages and significant damage to buildings, including the homes of many employees and patients, many medical practices were forced to close. Some practices along the coasts were unable to perform surgery for up to several weeks.

Our original timeline placed our EMR implementation around the late summer of 2005, but the domino effect from the storms forced us to push this back a couple of months. Unfortunately, this would coincide with a couple of other major events in our practice: the addition of a new associate and the construction of a new satellite office. Because we knew that the success of the EMR implementation depended on our full commitment and resources, we decided to push our "go-live" time back to the beginning of 2006.

Here, I have asked Frank E. Polack, PMP, past president of the Project Management Institute (PMI) Atlanta Chapter, to help me explain how a project manager can help a practice plan a process such as EMR implementation and also deal with unexpected events.

ILLUSTRATOR: MARK HEINE/ DEBORAH WOLFE, LTD

Sound Planning is Key

Previously, I wrote about the 10 principles of "change management" in regard to the culture of the organization. Instituting a change management program is a key step in ensuring success of a project.

Just as a good change management program can ensure that the office culture adapts to the new systems, implementation of the system needs a project manager. Many systems vendors will have their own project manager. You may consider having one as well.

A good way to start is to create a "project charter." The charter documents Why we are doing this (to avoid expanding office space and to keep accurate records), What we are implementing (an EMR system), How long it will take (to be running by March 2006), and What it is budgeted to cost (including software, hardware and training). Also included are Risks (hurricanes, virus attacks, vendor delays), Constraints (we can install cabling only after hours) and Assumptions (the schedule assumes that allocated resources will be available when they are needed).

Another important element is a scheduling tool such as Microsoft Project, or even Excel to track tasks. Also, consider keeping a Risk log (a list of Risks, their probability and impact, and mitigation plan) and an Issue log (items that come up that need attention). An Issue is often a Risk that has suddenly become a reality.

Cost, Time and Scope

PMI publishes standards for managing projects that include nine knowledge areas of project management. A project manager will employ processes from all nine areas to ensure that all aspects of the project are covered.

Of the nine areas, three are identified as the triple constraints: Cost (the budget), Time (the schedule), and Scope (the work to be done). If any one of these is changed, the others will also be affected. If you increase the Scope of the project (either through a change order or Scope "creep"), the Time to implement or the Cost will increase. If you try to lower the Cost, the Scope will need to be decreased or quality lowered (one coat of paint instead of two), or it may take more Time (e.g., fewer resources doing the work). Also, be aware of scheduling dependencies — Task B cannot start until Task A is complete.

Managing the Overall Project

Following are some of the key elements of managing a large-scale project:

Quality Management. Inspect regularly to ensure that what you are implementing satisfies the needs defined at the beginning of the project. Do not wait until the work is completed to see if it is being done right.

Risk Management. Identify and qualify possible risks for probability and impact; then quantify the costs in terms of money and affect on the project schedule.

A risk management plan helps you deal with the identified risks should they occur. For example, if you were to plan an outdoor party, you might mitigate the risk of rain by keeping a close watch on the weather report; you might avoid the risk by having the party indoors, or you might set aside a contingency fund to pay for tent rentals in case the weather turns bad. Risks need to be monitored on a regular basis. An event that has low probability or impact early in the project may have more impact later on.

Communication Management. Know what to communicate about the project, to whom and how. Key project team members may need constant updates, while the physicians may need less frequent updates. How often do you hold meetings and who is invited? Does the practice administrator have to be sent copies of every e-mail?

Procurement Management. Make sure you understand the type of contract you enter into with any vendor. Is it fixed price, cost-plus or T&M (time and materials)?

Human Resource Management. Know everyone who is on the project team. Who are the SMEs (subject matter experts, such as cabling or IT folks)? Are resources being assigned full-time to the project? Will the project manager have authority over each resource's time?

Integration Management. Take all the elements outlined above and ensure that they are all managed throughout the life of the project.

An important point that cannot be overemphasized: Project managers are available for hire and can lessen the pain and the cost of an implementation. Your local PMI chapter can be a great place to start (www.pmi.org)

In a multipart series, Dr. Polack is describing how a seven-partner practice, Ocala Eye in Ocala, Fla., with five locations and 140 employees, makes the major transition from paper medical records to EMR. During the course of the series, Dr. Polack will provide readers with a "real-time" look at how the implementation is progressing. This is part 10 of the series.

Next: Finding the Right Software

Peter J. Polack, M.D., F.A.C.S., is co-managing partner for Ocala Eye, PA, and a specialist in cornea, external disease and refractive surgery. Founded in 1971, Ocala Eye is a seven-partner, multisubspecialty ophthalmology practice located in Ocala, Fla. The practice, which has five locations including an ASC and laser center, has 140 employees. He can be reached by email at ppolack@ocalaeye.com.