By Angela Rose, MHA, RHIA, CHPS, FAHIMA
From encoders to electronic health records (EHRs), health information management (HIM) professionals are often tasked with enterprise-wide project management including new technologies, changing workflows, and centralized operations. Information technology (IT) system implementations and enterprise-wide HIM standardization initiatives are two of the most common examples.
These massive projects require strong HIM skills, expanded partnerships, and greater collaboration among vendors, HIM, IT, and others. Though HIM professionals have always managed projects, enterprise-wide endeavors raise the bar for communication, organization, and leadership. HIM professionals have unique abilities to manage enterprise-wide projects. With leadership skills, specialized education, and peer-to-peer relationships, HIM is perfectly positioned to promote collaboration among all stakeholders, secure executive support, ensure timelines are met, and cover every detail of an enterprise-wide initiative. Equally important, HIM professionals can help team members solve problems, achieve their goals, and enjoy the journey.
In this virtual roundtable, three HIM experts discuss how to map out enterprise-wide projects, meet milestones, and resolve common challenges. The discussion was moderated by Angela Rose, MHA, RHIA, CHPS, FAHIMA, director of client relations and account management at MRO, a health information disclosure management company, based in Norristown, PA.
Rose: Please provide a high-level overview of a recent enterprise-wide project and define your role.
Pat Biesboer, RHIA, MSS, PMP, senior project manager, based in Minneapolis, MN: Having worked in HIM my entire career, I transitioned to full-time project management in 2000. I served as the overall project manager for enterprise-wide EHR implementations along with numerous targeted projects in compliance, new facility acquisitions, application upgrades, and application rollouts to other facilities within an integrated health system. While each project scope varied, my role remained consistent across each assignment.
Susan Carey, MHI, RHIT, PMP, FAHIMA, system director of HIM at Norton Healthcare, one of Kentucky’s largest healthcare systems with more than 40 locations in and around Louisville, KY: We implemented our current EHR in 2012, so most of our projects relate to gaining operational efficiencies through technology. The latest enterprise-wide project was construction of an HIM contact center to handle a growing number of stakeholder inquiries that increased once we implemented all the EHR capabilities, especially the patient portal. The project scope included implementing new processes and technology to handle the volume of internal calls for release of information (ROI), portal support, information exchange, record amendments, and requests for system access. My role was executive sponsor for the project with two other HIM professionals serving as program manager and project business owner.
Emilie Sturm, MA, RHIA, CHPS, senior revenue management consultant at Trinity Health, a national Catholic health system with 93 hospitals and 122 continuing care facilities, home care agencies, and outpatient centers in 22 states: Standardizing operations for ROI is our current enterprise-wide project, designed to create standard tools for all Trinity HIM directors. The goal is to ensure a consistent experience for patients across our ministries while adhering to legislative and regulatory requirements for ROI. I serve as the project manager with chief responsibility to facilitate discussions, gather expertise, and solidify best practices in place across the health system.
Rose: How did you map out your goals for these projects?
Biesboer: Each enterprise-wide project includes defined leadership goals that add value to the customer, their organization, and their patients. These goals are documented in a project definition document or scope document. Changes require sponsor approval.
Leadership goals often correlate with an organization’s vision, mission, or strategic annual goals. The senior leadership team vets and prioritizes those goals. However, targeted interviews with sponsors and business owners help to solidify the actual real-world goals of any enterprise-wide project.
Actual goals are often not the same as those defined by senior leadership in the original project charter. Tried processes and situational leadership are used to pull the entire team toward the desired results.
Carey: The project manager interviewed all internal stakeholders and developed a goal statement. Once the statement was approved, a current-and-future state session was facilitated. In this session there are no rules, unnecessary questions, or limits. The group worked together to answer a single question: “In a perfect world this need of our HIM stakeholder would be met by __.” Project objectives were then extrapolated from the defined future state and broken down into work packages during a work breakdown structure (WBS) session.
Sturm: Taking HIM’s competing priorities and projects into consideration, we began by establishing short- and long-term goals for the project. Next, we prioritized goals against strategic objectives and timelines for the organization as a whole. Internal and external factors influenced our decisions for each phase. Key leaders provided feedback on our project plan to ensure effective use of resources.
Rose: How did you ensure timelines and milestones were met?
Biesboer: I identify the work of the project using a WBS. The WBS is a block diagram of the key buckets of work broken down into one or two levels. From the WBS, a list of tasks is created and sequenced into a project schedule with brightly colored Excel bar graphs if the detail of a Microsoft Project tool isn’t warranted.
This grid of tasks by calendar weeks drives the project team’s weekly meeting agendas, ensuring the right tasks are done at the right times without missing key steps. If a milestone ever appears to be in jeopardy, the whole group is aware and we quickly discuss options to get back on course.
Beyond this process, three specific tactics ensure all projects meet established timelines and milestones:
- Set expectations early and repetitively.
- Be proactive by negotiating options and alternative solutions.
- Focus on achieving milestones during every phase—avoid being reactive.
Carey: A project schedule was developed from the work packages identified in the WBS session similar to the process described above. Dates, durations, and responsible parties were assigned to each work package and the schedule was reviewed weekly during project meetings. The schedule and other project documentation were also posted on an HIM SharePoint site for staff to view progress.
Simply sending out the project schedule via email does not facilitate accountability and responsibility. When you convene the responsible parties in person, they are more likely to complete tasks or alert the project manager to roadblocks versus publicly report “no update.” This process requires a strong project manager who can firmly push team members who have not completed tasks in a timely or appropriate manner.
Sturm: Communication is key throughout any project. Our team established regular touch points to provide progress on deliverables. Timeframes were created to meet each goal while specifying the resources required to complete the milestone. Our project progress reports used the stoplight rating system to quickly see the status of each task.
Rose: Describe any challenges with scope creep and how you addressed them.
Biesboer: There are forces and tendencies toward scope creep in every project. However, scope creep can be avoided by taking these four steps:
- Clearly document what is in scope and what is out of scope.
- Have project sponsors and business owners sign off on the document that includes scope definition.
- Respond to any requests outside the scope document with a discussion. Scope can be changed, but sponsor approval is required along with clear and documented understanding of how the change impacts budget, timeline, schedule, and other key projects.
- Walk through all implications of any scope change and ensure stakeholders walk in the shoes of affected users.
One project is never an island. The enterprise (and vendor) view of priority, time, and resources must be taken into account when considering scope change.
Carey: I have yet to participate in a project without scope creep. In pursuit of the perfect future state, some tasks may be too costly or too dependent on external factors beyond your control. For example, during our contact center project, the team wanted to build an elaborate, cost-prohibitive tree hierarchy. We had no budget for the added functionality. In this case, scope creep was easily averted. To properly handle the situation, I took the following steps:
- Identify the driver of the project—cost, quality, or time.
- Measure any change to the approved scope against that driver.
- Evaluate changes to determine additional costs.
- Submit a request for additional funding if the change is warranted.
Sturm: In the early stages of the project, I asked my HIM colleagues to share their ideal ROI resources and build a wish list of references for everyday use among our teams. This list became the goals or proposed output for the project. Those same colleagues formed a work group to combine skills, ROI practice tools, and expertise to develop the requested references. This work defined a set of standards, which helped to minimize scope creep.
One project challenge involved the instances of ROI that occur outside acute care HIM. The scope of the project was intended to address only acute care and we had to scale back opportunities to include other areas of our organization. In future phases of the project, we may be able to share resources or increase the scale of the ROI operations.
Rose: As an HIM professional, what was your biggest challenge in managing a large implementation project?
Biesboer: A big challenge is keeping all disciplines moving forward at the same pace and understanding the status of each group’s progress. During EHR implementations, I asked each specialty (hospital and vendor) to estimate a percentage of completion each week during the build/configuration stage. We documented weekly estimates to measure forward or backward movement, identify underlying factors, and determine how other groups could help keep efforts on track. We avoided blaming and focused on moving forward.
It is easy to get bogged down in issue resolution. Here are several tactics I use to manage large implementations:
- Ask the team to prioritize issues.
- Address the highs first, then later address the medium and low issues.
- Provide weekly status reports with green, yellow, and red indicators to show a quick view of progress.
- Graph open versus closed issues and other key indicators so the team could easily see and enjoy progress.
Key stakeholders were also given green, yellow, and red indicator status reports showing progress, successes, and blockers. Big blockers may require advance verbal communication with executives.
Finally, as an HIM professional it is important to earn trust of project sponsors, key executives, and business owners early in the project. Listen and be responsive. When large issues arise, you’ll have a bank of trust, and key stakeholders will help remove barriers or grant forgiveness when human errors occur.
Carey: The biggest challenge for our project was conveying the need for HIM to establish a contact center. Many across our organization had no idea of the volume and variety of inquiries received by HIM on a daily basis until we produced call volume reports. Solid data is a proven ally for HIM professionals during enterprise-wide initiatives.
Sturm: The biggest challenge within ROI is ensuring the privacy and security of our patients’ health information. Both state and federal regulations have a tremendous impact on our ROI operations along with the policies and procedures we create. With the implementation scope reaching multiple states, our tools had to account for state and federal differences or be fluid to plug in specific state verbiage where required.
Rose: Provide three important lessons learned that other HIM professionals should know.
Biesboer: The three main lessons learned during my repeated experiences as an enterprise-wide project manager include:
- Keep people motivated by providing concise, timely, and honest communication. Inject fun into your discussions and keep the current status in front of stakeholders according to a regular schedule, providing the degree of detail they need.
- Earn trust through realistic expectations and transparency. If difficulties are expected, prepare the team ahead of time.
- Guide the team toward their stated goals. When you run into blockers, review your options. Objectively provide the background, options, rationale, and a recommended direction to maintain forward progress.
Carey: The most significant lesson learned is to avoid bringing assumptions to the table. Remain open-minded and validate your expectations. When I was the project manager for our EHR’s operating room, nursing, and HIM modules, I mistakenly assumed that IT resources understood HIM. Looking back, I should have educated my peers who were managing other parts of the project regarding the tenets of HIM. This would have facilitated HIM operations leaders’ attempts to maintain decision-making regarding the electronic record configurations and policy.
I also suggest conducting reference calls with organizations using any technology you are considering. HIM needs differ from those of other departments. Current users can suggest ways to configure applications to best meet your needs and save valuable implementation time and resources. Perform as a project manager with HIM knowledge. Project managers are valuable when they have subject matter expertise and can develop subsidiary plans within the overall project management plan.
Sturm: It’s important to have the right stakeholders at the table when starting a project. Due diligence should be conducted to map out all areas of the project and determine vested parties. Having the right team on board provides for a productive group of multidisciplinary professionals with varying expertise.
With a multiphase project, such as a system rollout, identify lessons learned during each phase. When possible, incorporate those lessons into the next phase for a stronger outcome. As your timeline allows, be flexible and don’t hesitate to postpone a go-live if critical goals are not yet achieved.
Communicate often with your project team and stakeholders. For HIM-driven projects, it’s critical that the local HIM director communicates with key constituents or peers. Establish regular meeting schedules during the course of the project or expand your schedule if necessary. Disseminate project management tools such as timelines and meeting minutes to the project team. Regularly review the project plan to monitor progress compared with the overall timelines.
Angela Rose (firstname.lastname@example.org) is director of client relations and account management at MRO.
Rose, Angela Dinh.
"Using HIM Skills to Lead Enterprise-Wide Projects: An Expert Roundtable"
Journal of AHIMA