Today, Governor Doyle announced our plans to create the largest patient database in the state of Wisconsin.  We appreciate the recognition from Madison and the inspiration we received from the governor’s e-health initiative.  Both efforts recognize that information silos are limiting quality of care and patient safety.

In April 2006 a group of key Ministry IT, Business and Clinical Leaders collaborated to develop an Electronic Health Record (EHR) vision that has served us well over the last two years as we developed our Clinical IT Strategy.

By the end of June 2006, using that vision as our foundation, we identified the need for a single Electronic Health Record to be shared across all of our Ministry Medical Group Clinics and hospitals in Central and Northern Wisconsin.  In addition to the need for a single, shared electronic health record we realized that our greatest clinical functionality gap exists in our medical groups.  We set out to find the best solution to provide us that single patient database and revolutionize how we care for patients in our clinics.

Ministry used a traditional system selection process to look at all of the established options in the market place.  Through our Request for Proposal process we developed a short list of options that included Epic, GE and a commercial product that the Marshfield Clinic was bringing to market: CattailsMD.

I was very hesitant about the notion of buying a new product, especially one that was developed by a company that has not traditionally sold software.  However, the opportunity to expand our vision for a shared patient database beyond our organization to include our largest patient care partners was too important not to consider.

I strongly believe that our selection process was very thorough.  we laid out the options to key leaders and medical staff members who challenged us to be very thorough in our analysis. A thorough selection of this magnitude requires a great deal of time.

In August 2007 I recommended to the Ministry board of Directors that we name CattailsMD as our Ministry-wide EHR vendor of choice.  I actually did not think this is where we would end, but we have been very surprised how well the CattailsMD offering has stacked up to the competition.  We are also very excited about their willingness to include Ministry as equal partners in the development of the product, even before the contract was signed.  We have identified 6 critical enhancements and developed details specifications.

However, we committed to the board a full business case.  We did not want to have the same experience as others that have had clinical IT projects that have run well over plan (schedule and cost).  I have half-jokingly reminded my team that our primary indicator of success will be CIO retention.  If I am still at Ministry at the end of this effort that means we did it properly.  The most important aspect of success is the preparation.

We spent 8 months developing detailed plans and testing the most technically challenging aspects of the project.  all of this was done in partnership with Marshfield Clinic without a committeemen to purchase their offering.  This level of collaboration would not exist with a traditional software vendor.  It is refreshing to have a partner with the same level of commitment to a mutually agreed upon definition of success.

This decision meant that over 1,000 doctors in our region of Wisconsin will share an Electronic Health Record.  They will jointly contribute to patient’s single medication, allergy, immunization and problem lists.  All patient care documentation will be accessible anywhere and immediately.  I believe that RHIOs (aka CHINS) have largely been a failure.  If we want real integration today, that is a quantum leap in patient care, it is clear to me that a shared electronic health record is the best way to accomplish this.

Of course I am the CIO at Affinity Health System as well.  They are observing Ministry’s progress as they look at their EHR options.

Today, many hospitals are extending the electronic records to their non-employed medical staff.  Ministry’s approach turns that model upside down.  Instead, we are purchasing an EHR from our physicians.

Now that this announcement is public I will have lots more to share.  It is my intention to use this forum to be very candid about our experience.  I believe part of our mission includes sharing what works and what was not ideal so others can improve their care, even our competitors.

I am so thankful for those that have made this happen.  Our planning project alone was 12,000 hours of effort.  It has been an incredible collaboration of medical group leadership, practicing physicians, senior leadership, Ministry’s project management office and IT.

I never really used Outlook’s To Do list. I tried a couple of times, but it became overwhelming and there was not enough functionality to assign deadlines, add notes and stratify tasks. So, I managed my To Do list in my Inbox and in my mind.

After a number of positive comments rememberthemilk.com (or rmilk.com for short) I decided t try managing my life online. So far so good. This web 2.0 application is proving to be have enough boost of functionality to make it worthwhile. I am almost always wired, so I use it in my browser. There is a BlackBerry sync, but I have not tried that.

I will let you know if I stick with it.

Leapfrog has released a CPOE test. This does not appear to be the tool that Leapfrog promised in 2001. The tool was supposed to be developed by FCG. There is no mention of FCG (or their new owner, CSC) in the press release.

In 2008 Leapfrog won’t be releasing the results. However, the hospitals will need to pass the test in order to claim that they have fully implemented the CPOE leap. I am predicting this will be delayed. But, I am a skeptic. Perhaps I should not be. There has been a lot of positive progress at the Leapfrog Group in the short time since Leah Binder took office in March 2008. We are finally moving the CPOE leap from an honor system. That is to be applauded.

It will be interesting to see the impact on the total number of hospitals making the leap. If the test is added to the 2009 CPOE leap requirement I suspect we will see a decline of hospitals meeting that standard.

In January 2006 I counted 63 hospitals claiming to have made the CPOE leap and another 58 claiming to be within 12 months of that goal. This month I count 144 hospitals claiming CPOE implementations that meet Leapfrog definition. I will let you decide if that is good progress or not. Anecdotally, the three in my area that said they were 12 months away at the start of 2006 are still not claiming the leap. One is still 12 months away and the other two are now claiming to be in the planning stages. I guess that is the nature of an honor reporting system that has no real incentives.

I wish Leapfrog were doing more to publish an analysis of their surveys. I had to add up 50 different separate queries to do this math. There are still a lot of questions. What percent of hospitals submit a survey? What percent of those are claiming full implementation of CPOE and other leaps? Which software vendors are supporting CPOE? When I have spare time I will do some more investigation.

When I was with APM I learned the phrase “pre-wire.”  A pre-wire is simply the meeting before the meeting.  As consultants it was important to share the meeting agenda with the customer and be aware of any concerns that they may have.  As a manager I still find pre-wires important.  For example, we always review the IT Steering Committee agenda with the chairperson a few days in advance of the meeting.  The better prepared I am for the pre-wire the better the Steering Committee meeting will go.

Whenever you are trying to get approval for an important decision it is always a good idea to have pre-wire meetings with all of the major decision-makers.  Often, just taking the time to meet with meeting attendees in advance is enough to make them sympathetic to your position.  A good manager will know the outcome before the meeting ever starts.

My recent post on project failure was one of my all-time favorites. While I wrote about failure from the top of my head, the reader comments were really well considered. Between my thoughts and the reader observations I think we have a great summary of the main reasons IT projects fail. I plan to turn that into a presentation.

Of course you do not want projects to fail. The preferred alternative is success. But there is a 3rd option, if a project is clearly not meeting your expectations you should kill it. Wayward projects are those suffering from cost and schedule overruns; are clearly going to require more resources than planned; and/or are not going to meet the original expected benefits.

Our organization has learned to embrace killing projects. And I think it is very healthy. In the recent Baseline Magazine, there is an excellent article on Project Lust. The story quotes Michael Krigsman, CEO of Asuret, a project-management consultancy: “It’s very common to see both IT and the line-of-business folks become enamored with a project and continue, blinded by the risks, when a third-party objective participant would say that there is failure coming down the line out there”

I believe project lust is common in most corporate cultures. The result is throwing good money after bad. At Ministry our IT Steering Committee congratulates business leaders that have the insight to see when something will not meet the planned expectations and having the courage to kill the project.

Every year we refine our project to discipline to better ensure success. But we are still a long way from perfect. Bad IT projects are still a fact of life. Killing them preserves your resources for the good stuff. I would encourage IT and organizational leaders to let embrace the idea of killing projects as something much better than failure.

The starting point for all of this is having the discipline to determine the success (or failure) of each project. If everything completed is considered a success, then there is no reason to stop.

If you are not killing a project or two each year you are going to suffer more failures.

I am writing this post from my primary home PC, which runs Windows Vista. As I switch between it and my work PC, which runs XP, I would be hard pressed to tell you the difference. The only things that come to mind are:

• Vista’s radically different Search user interface and
• User Access Control.

I find both annoying. But, I am a geek and when I am home I enjoy trying out the latest and greatest. I also have a MacBook running OS X Leopard and my old home built PC runs Ubuntu Linux (I had time to build PCs?).

Other than some minor annoyances I like Vista and I would not consider switching back to XP.  I would also add that there are annoyances with all of these Operating Systems.  I find Apple’s Vista claims disengenuous.  I found just as many OS X Leopard annoyances and incompatibilities.  For example, my SuperDuper backup would not work and I could no longer import my Flip video into the new version of iMovie.

But, when I am working I am a business person. Every day I am faced with a limitless number of opportunities to make Ministry and Affinity a better place for our patients, doctors and employees. Upgrading the operating system on our 14,000 PCs is not on that list of opportunities. That is why we are taking a pass on Vista. Not that anything is wrong with Vista. It works great for me. But I would rather spend our team’s time working on electronic health records, patient safety initiatives and reducing the cost of healthcare to our Wisconsin communities.

Testing Vista alone would take thousands of hours. Getting our users acclamated to the OS would be another huge investment in time. When you are multiplying everything by 14,000 it adds up quickly.

USA Today has an article on Vista and I am quoted liberally (more than John Halamka - woohoo). I thought Jeff Graham did I nice job with the article. But, I love having a blog because it gives me a chance to expand on the quotes in the article.

On a personal note, the USA Today photographer came out to our Weston facility and took about 200 pictures of me and about 5 of some of our employees doing their day-to-day work. Despite having the dds in my favor, It appears from the online version to go with one of the pictures without me. Actually, that is the way it should be. These are the people providing the service to our patients. IT is a support department and we should be in the background.  Update: I just got the print version.  I see there is a photo of me too.  The caption made me cringe a little.  How do I look?

My goal here is to post original content.  I generally don’t like to use this space to comment on someone else’s work.  But this InfoWorld article quotes me.  So, in the interest of self-promotion I am linking to it here:

Guerrilla IT: How to stop worrying and learn to love your superusers

I have always embraced our tech savvy employees.  They are my people.  When others were writing Internet Access policies that restricted employees use to “business-related sites,” we were encouraging people to join the Internet revolution.

I realize that IT cannot meet every possible need.  With tools like QuickBase we can unleash our tech savvy employees to meet their own needs, while keeping them in a sandbox.

As a bonus, the story also talks about Maureen Vadini, a former Parma Community General Hospital nurse that moved to IT to implement the Vocera communicator.

Speaking of Parma, does anyone else my age remember the Ghoul.  I think he was local to Detroit.

My person approach to IT management centers around success.  Most IT projects fail.  Some quite spectacularly, but most in a quieter way.  I believe these are the three leading contributors to failure:

Poor Project Plans and Resource Allocation

My personal experience is that most IT departments do not have a good sense for the amount of time they have to spend on IT projects.  All of the data I have collected since I have been studying this suggests that only 15% to 25% of total staff time is available to work on new projects.  If organizations take on more work than they can complete, everything proceeds at a snail’s pace and nothing ever truly gets done.

The only way to manage resources in a large organization is to have detailed plans for every project and to look at the resource requirements across all of your plans.

Vendor Performance

Just as IT departments over-allocate their resources, so do vendors.  Vendor performance issues are usually more related to them not providing services in the time expected (or not having a common expectation with the vendor) than bad software.  However, sucky software is still an issue.

Lack of Clear Expectations

If someone’s goal is just to implement some software than, in my opinion, they have failed by default.  Each IT implementation should have clear business benefits and those benefits need to remain insight throught the effort.

Am I missing other common contributors to failure?

The most retail sales, per square foot, take place in airports.  20 years ago, you were lucky to have an airport cafe.  Entrepreneurial organizations are now seeing the same growth potential in hospitals.

If organizations like Simply Retail have their way, our Starbucks kiosks will be the tip of the retail sales iceberg.  They are partnering with healthcare organizations to plan retail stores within their hospitals, especially new facilities.

I love the idea.  There are always people looking for time to pass, offering them a shopping experience is a win-win.  If only I could get one of my hospitals to open a Best Buy.

There is a role for super users to provide just in time training and to serve as moderators of user groups. However, there is a tendency for folks to believe that the super user is the person that handles anything above the most routine use of the technology. Having super users cannot reduce the expectations of the rest of the work force. Every employee must be tech savvy and leverage the tolls provided in order for us to have any hope f achieving a return on our very expensive IT investments.

What do you think?