Health Information Management: Integrating Information Technology ...

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STRATEGY, IMPLEMENTATION AND EVALUATION 185 included, amongst others, fully fledged order communication with advanced order-set functions, integrated patient planning based on a central patient agenda, a highly flexible forms generator to support customized electronic record building, and so forth. Before moving on to the advanced PCIS functions, of course, the project started with ensuring that the traditional functions supported by the old HIS would be properly replaced. After two years, having lost the Board of Directors, the project manager, and surviving a near bankruptcy, the old HIS’s functions had been replaced with the new HIS/PCIS. This implementation had taken three times the money and twice the time as had been planned. In hindsight, the main reason was that the new HIS/ PCIS required that a patient episode had to be selected or registered and an order had to be entered before any other action could be initiated for a patient. Only after having done this, for example, could an admission be performed, or an [outpatient visit be planned. Administrative personnel, nurses and doctors alike [revolted at this seemingly unworkable process. Now, seven years later, the nuisance of obligatory order entry and episode registration have been removed from the system by reprogramming parts of it. The basic HIS functions perform adequately. Recently, the medical staff has requested permission from the BoD to start a scan of the marketplace to find an innovative PCIS. some beacons have to be decided upon to always keep in view. Amongst such beacons, an initial set of parameters for the desired goals, time and budget ranks high. In addition, the project organization can be designed to optimize possibilities for the steering of such enterprises as embarked upon here. First of all, it should be a project organization that is capable of recognizing the need to redefine goals, time and budget, and has the structure to do so. Second, it should be a project organization that is capable of measuring progress and making decisions that ensure continuing progress. PCIS implementation in health care will likely fail unless focused effort is taken to structure the detailed decision making process by a broad group of professionals. This decision making process is fundamental to designing redesigned or new work processes—the basis of a successful PCIS implementation. DEFINE THE PROJECT Project management starts with the process of defining the project at hand. Given the insights from the previous chapter about the ‘learn as you go’ nature of PCIS projects (or any innovative project), the project definition should reflect the dual aim of reaching specific targets and learning from the process of doing so. This goes as far as to make redefining the targets based on what is learned, part of the project. This is as good a recursive definition as you will find! In practice, a trade off is made between having targets and being able to learn as you go (and thus changing them), through phasing the project. First an overall
186 PROJECT MANAGEMENT definition is made by stating what business objectives the project should serve (see also Chapter 8). For example: the project implementation of a Medication System aims to reduce medication errors. Or: the project implementation of a Physician Order Entry System aims to fundamentally improve patient logistics. Then the project is phased in time by defining intermediate goals. The end of each phase is a natural moment for a thorough evaluation and a rethinking of the targets for the next phase, based on what was learned (see also the next chapter). For example: ‘the project Electronic Prescription System phase 1 is the proof-ofconcept pilot at cardiology. Phase 2 is implementing the system in the whole of internal medicine. Further implementation is to be defined after completion of phase 2.’ Phase the project smartly Phasing PCIS projects is crucial. Phasing is basically about reducing complexity. This is much needed, because with the often large scope and high ambition of PCIS projects, uncertainty and unpredictability are high as well. One is looking for ways to divide the project into building blocks (phases) around intermediate goals that can be delivered with less uncertainty and unpredictability. Delivering a pilot implementation, as ‘proof of concept’, is in almost all innovative PCIS implementations a good first phase. Delivering the pilot means that the application and its technical infrastructure are working technically correctly, freeing up time and energy to focus on getting the work processes right before attempting a next step. Other lines along which to phase a PCIS implementation are for example first delivering parts of the project that can be termed as purely technical (e.g. technical infrastructure), or parts of the project that bring the user added value without requiring a change in his work process (e.g. showing examination results). Another example is phasing by sequentially delivering discrete steps of the total work process, e.g. first improving patient intake, then improving patient discharge, and only then starting on patient throughput and integrated patient planning. Many projects go wrong when after the termination of a pilot phase, ‘roll out’ is defined as the next phase. A sudden increase in scope of the project increases its uncertainty and unpredictability. Proper time should be allotted for the organization and technology to learn from each other. That is to say: incremental change, introducing smartly dosed next steps one by one, is an ideal way to allow optimal learning from unexpected problems and synergies. CASE VIGNETTE When setting high ambitions in care process redesign and IT process support, as in the case of Southern Medical (see Chapter 8), it is important to start work around substantial patient flows. Importantly, care areas should be targeted where ‘quick wins’ can be achieved, and where professionals frequently
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Health Information Management In al
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Health Information Management Integ
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Contents List of illustrations vii
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Illustrations FIGURES 3.1 Medicatio
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Contributors Marc Berg is a physici
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Series preface In almost all Wester
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Acknowledgements I would like to th
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Chapter 1 Introduction In all Weste
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INTRODUCTION 3 touch upon the deplo
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INTRODUCTION 5 can draw upon to mai
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INTRODUCTION 7 Physician Order Entr
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Part I Starting points Understandin
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WAITING FOR GODOT 11 KEY TERMS ■
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WAITING FOR GODOT 13 Netherlands an
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WAITING FOR GODOT 15 facts to show
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WAITING FOR GODOT 17 (Lewinski-Corw
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WAITING FOR GODOT 19 In most cases,
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WAITING FOR GODOT 21 (Anonymous 191
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WAITING FOR GODOT 23 Because of the
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WAITING FOR GODOT 25 they simply sa
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WAITING FOR GODOT 27 expected. Stil
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WAITING FOR GODOT 29 organize their
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WAITING FOR GODOT 31 performance in
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WAITING FOR GODOT 33 different HIS
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WAITING FOR GODOT 35 CONCLUSION: TH
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WAITING FOR GODOT 37 assumption tha
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WAITING FOR GODOT 39 Anonymous (191
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WAITING FOR GODOT 41 Berg, M. (1997
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Chapter 3 Health care work and pati
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HEALTH CARE WORK AND INFORMATION SY
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THE CONTEXTUAL NATURE OF INFORMATIO
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Chapter 5 Meeting the challenge Int
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STARTING POINTS 81 ‘gender, race,
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STARTING POINTS 83 Now, imagine an
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STARTING POINTS 85 organization,
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STARTING POINTS 87 Figure 5.2 Incre
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STARTING POINTS 89 already overflow
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STARTING POINTS 91 responsibilities
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STARTING POINTS 93 answer the quest
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STARTING POINTS 95 Kohn, L.T., J.M.
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Chapter 6 Designing interactions En
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DESIGNING INTERACTIONS 99 the way t
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DESIGNING INTERACTIONS 101 1 Identi
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DESIGNING INTERACTIONS 103 the deve
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DESIGNING INTERACTIONS 105 communic
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DESIGNING INTERACTIONS 107 Figure 6
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DESIGNING INTERACTIONS 109 ■ Figu
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DESIGNING INTERACTIONS 111 measurem
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DESIGNING INTERACTIONS 117 Covell D
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Part II Information strategy, imple
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INFORMATION STRATEGY: AN INTRODUCTI
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Page 150 and 151: INFORMATION STRATEGY: AN INTRODUCTI
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Page 240 and 241: INDEX 225 satisfaction 176 patient
Page 242: INDEX 227 support 164 technology de
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