CPOE Scope Management:

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CPOE Scope Management MEDITECH CIO Forum Chris
Parisi Sr. Project ManagerNewton-Wellesley
Hospital 06/15/06
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Background MBA from Bentley 20 years in info
tech 10 years in health care info tech IDX, SDK
(Now Eclipsys) NMC Homecare, Harte-Hanks, Lycos,
iMarket/DNB Graduate Instructor, University of
Phoenix Online, I.T. Project Management
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And now - Newton-Wellesley Hospital
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Newton-Wellesley Hospital

• Partners Affiliate
• Teaching Facility with Resident Rotations
• Mid-Sized Community Hospital - 250 Beds
• 1 Pediatric Unit 1 Special Care Nursery
• 1 Telemetry, 1 Med Oncology 1 Med/Surg
• Pediatrics Maternal Child Health
• 1 Surgical Unit PACU
• Psych (two divisions)

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CPOE Scope Management
Did your project ask for this
and you ended up building this???
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CPOE Scope Management
Welcome to CPOE Project Scope Management!
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Scope Management Definition
What is Project Scope Management? The complete
understanding and management of exactly what is
and what is not to be delivered within the
project
And involves Initiation, Planning, Definition,
and Verification of the features and
functionality required for completion of the
project.
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Scope Management Definition

• Scope Management is centered around
• Controlling Changes to the defined requirements
  of the project
• - and managing Scope Creep

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Project Management

• Projects are steered by the business needs of an
  organization
• and influenced by the Triple Constraint
• Scope
• Time
• Resources

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CPOE Scope Management the HIS Environment
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Some Questions to ask
Lets talk about CPOE for a minute

• Projects are steered by the Business Need
• What is the organizations strategic direction?
• How would the project address this strategy?
• What are the projects benefits?
• How are they greater than another projects which
  is looking for the same resources?

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Motivation for CPOE

• Newton-Wellesley Hospitals ongoing commitment to
  patient safety
• Improve patient care
• JCAHO (ongoing Patient Safety Program)
• Pay-for-performance guidelines (Leapfrog)

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Scope Management Tools

• The Project Charter is one of the most important
  documents that you will create, and lets
  everybody know
• The direction and deliverables of the project
• The people and resources involved
• The approach being taken

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PM Tools Techniques

Note CLINICALLY driven project, not IT
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PM Tools Techniques
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CPOE Scope Management Quantifiable Success
Factors Scope All Inpatient units LIVE on
CPOE Time 75 LIVE by end of 2005 all by end
of 2006 Cost under 1,500,000
Keys to a successful CPOE implementation Scope
Statement Quantifiable Success Factors in terms
of Scope, Time, Cost and Quality
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Scope Management
Two of the three top factors identified by the
Standish Group as scope problems were Lack of
User Input, and Incomplete Requirements and
Specifications
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NWH CPOE Scope Management The Teams

• CPOE Scope Management NWH Project Team
• Project manager
• Consultants (one full-, one part-time)
• Physician lead (part-time)
• Nursing lead (full-time)
• Pharmacy lead (full-time)
• Network/Hardware representation
• Guests from upcoming units
• Project Manager, Physician Nurse Lead and CIO
  sat on CPOE Steering Committee

• CPOE Steering Committee
• Senior Staff, Physicians, IT, Nursing, Education
• Pharmacy CPOE Committee
• Pharmacists, Consultants, Nursing
• Nursing Practice CPOE committee
• Physician Advisory Committee
• IS Steering Committee
• Directors, Physicians, Nursing

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CPOE - Scope Management
This does not mean that there will not be Change!
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Scope Management
There will always be change in a project, and
factors that you have no control over. In a
dynamic world, and a dynamic industry Change
is unavoidable.
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Scope Management
Scope Creep is the tendency for the requirements
of a project to grow past the initial scope
statement and verification According to the
Standish Group, it is the third most common
Project Problem!
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NWH HIS Project Management
Scope
The Triple Constraint
Resources
Time
Cant Change One without impacting the other Two
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Scope Management
There is no such thing as a free lunch!
If there are no trade-offs there can be no
successful change
You cannot have a change in scope without some
kind of impact on cost and time
It is much easier to implement a change earlier
in the project life cycle than it is in the later
stages
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NWH HIS Project Management
The later change is introduced, the more costly
to implement
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Scope Management
Time can be the greatest obstacle in project
management, and scope creep hits the time
constraint the hardest.
A recent CHAOS report from the Standish Group
states that the average time overrun on
unsuccessful I.T. projects was 222.
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Scope Management

• When is Scope Change Ok?
• New requirements are justified
• Impact to the project is analyzed and understood
• Trade-offs are approved by the Steering Committee

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Some Scope Change Guidelines
Priority CRITICAL project cannot proceed
because the change is critical for project
success IMPORTANT significant negative impacts
or major opportunities missed if the change is
not made DESIRABLE benefits outweigh costs, but
project can succeed without the change POST-LIVE
- the change should be evaluated for inclusion on
the project evolution plan
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Example 1 of CPOE Change Management

• NWH CPOE Project
• Wireless Network Phase Initial Scope
• Enable all inpatient locations
• Infrastructure to support 802.11a,b,g thru x
• Support Leapfrog authentication
• Scale to 3x existing concurrent user access

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Example 1 of CPOE Change Management
What Changed Requirements did not
change But The network as installed in the pilot
did not perform to spec
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Example 1 of CPOE Change Management

• Implementation based on discovery
• Floor plans relayed optimal placement of wireless
  access points (APs)
• Standard configuration was a linear
  infrastructure

That means that the APs were laid in a straight
line down the middle of the unit!
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Example 1 of CPOE Change Management

• How did Change Evolve?
• Pilot testing showed
• drop-outs in connection lost orders, rekeying
  needed, no pattern immediately evident
• slow response times

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Example 1 of CPOE Change Management
Why the Changes? Wireless connectivity was
required for project success Pilot did its job
showed whether current project build would work
or not in a production environment
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Example 1 of CPOE Change Management

• What ended up changing?
• Network engineering worked with hospital
  engineering staff
• Found detailed blueprints and opened up walls
  that showed cold water copper plumbing and walls
  causing interference

• Changed placements to a Diamond configuration

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Example 1 of CPOE Change Management

• Initial Impact?
• CPOE Pilot extended to verify that wireless
  changes addressed problems

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NWH HIS Project Management
Estimated 300 hrs labor during Rollout
Approx 30 hrs labor at Pilot
The later change is introduced, the more costly
to implement
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Example 1 of CPOE Change Management

• And the Tradeoffs?
• Minimal!
• Production rollout start date was NOT changed
  slack built into project plan allowed for
  adjustments
• Minor cost impact discovery made in time to
  address before network rolled out to production
  floors

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Example 2 of CPOE Change Management

• NWH CPOE Project
• Original Rollout Plan
• Enable All Med/Surg Units 1st
• Enable PACU admits after Inpatient units stable

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Example 2 of CPOE Change Management
What Changed Requirements did not
change But The plan changed based upon feedback
from Ortho/Neuro Surg Inpatient unit mgrs Desire
was to have all patients go on-line at same time
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Example 2 of CPOE Change Management

• Why the Changes?
• Remember Success Factors - User feedback and
  input is crucial theyre our customers!
• Project Team listened to the reasons
• Easier for staff to not have to decide which
  patients stayed on paper
• Less confusion when learning the new system and
  process

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Example 2 of CPOE Change Management

• What ended up Changing?
• Project Team juggled the rollout schedule to
  allow sufficient Discovery Time for PACU Admit
  specifications
• CPOE Steering Committee approved schedule
  adjustments Justified change

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Example 2 of CPOE Change Management

• Initial Impact?
• CPOE Rollout Delayed several weeks to adjust to
  new plan

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Example 2 of CPOE Change Management

• And the Tradeoffs?
• Again - Minimal!
• Production rollout dates shifted but
• No overall rollout impact Project Team shifted
  their approach
• Time spent in PACU to floor discovery performed
  earlier than anticipated - made up time later on
  in the project

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What Contributed to our Success?

• Senior Staff support great leadership!
• Mandated use of system
• Communicated well between groups
• Well orchestrated and documented rollout plan
• Learned from each unit and moved forward
  immediately
• Built a strong team and recognized excellence
• This is the most intense team effort youll ever
  encounter

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Example of CPOE Scope Management
Final Result? CPOE rollout completed ahead of
schedule under budget and
its looking great!!!
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Example of Scope Management
Questions? Contact info Cparisi_at_partners.org 61
7-243-6702