It's not a good sign when the IT department has retreated to a corner and won't come out. That was only half the problem Jamie Gianna encountered when he was hired as COMHAR Inc.'s CIO in 2008 to kick start a stalled electronic health records
The goals of the project were to digitize the heavily paper-based billing and health records as well as centralize information within one EHR system. The community health care provider had tried putting IT in charge of the project as well as a project manager, but none had managed to get all of the project owners together.
When Gianna arrived, most of the 800 employees at the Philadelphia-based company blamed the IT team for the stalled EHR project. The administrators and the clinical side of the house, however, were pointing fingers at each other. Gianna spent his first weeks at COMHAR talking to all the different stakeholders involved in the EHR project.
Every time the [project owners] met, they would push up new features and functionality that they wanted above existing phases of the project that hadn’t been done yet.
When Gianna approached the project's stakeholders, instead of whipping out a project management framework, he wrote down a project plan on a single piece of paper and presented it to IT. "I purposely left out steps and milestones and told them to come back the next day. Of course, they told me my plan was missing steps, but that was the point: They were engaged again and following the same plan."
And in the process, Gianni and his team of six full-time staffers and two part-time consultants began managing the EHR project expectations. The EHR vendor had overpromised what the system could deliver, pushing the project out of scope. "No one was in charge of managing expectations," he said. "Every time the [project owners] met, they would push up new features and functionality that they wanted above existing phases of the project that hadn't been done yet."
With a simple, phased project in place, project owners had to come to Gianna for special requests. " I said, ‘Please tell me what you want, I'll document it, and when we finish this phase of the project, we'll look at what value your changes will bring to the business, the cost and the ROI.’ Some were happy with this approach, some were not, but you have to give them tough love."
The first area that Gianna tackled was the expectation of insurance providers to transmit billing and patient information electronically. It took about a year to get the EHR project stable and each business unit on the system. The next year was spent adding the features and functions -- many of which had to be customized -- that the business units needed to function independently and cross-group.
Today, the EHR system is fully installed: All billing, services and reporting information is transmitted electronically. It has all of the "bells and whistles" asked for -- that added value, of course -- and the "finishing touches" are being put on its clinical history records system.
Business intelligence a logical step
Now that Gianna has the EHR system squared away, he's turning his attention to business intelligence and data mining. "We have 25 years’ worth of data that we want to put into perspective," he said. There are information silos that need to be centralized within the EHR system. "From a reporting and BI standpoint, we can't make important decisions without having that information centralized. Everyone has been able to recognize that as soon as we started producing accurate reports."
Project management resources
When members of the board of directors wants to see patient activity, like how many patients were treated by one of COMHAR's 46 sites, they can use the intranet connected to the central EHR system. The system will also be connected to census data to gather demographics. "We need to be able to see if the population is changing. If there are more children, do we have those services, and do we have them before someone else walks into our backyard and provides them?"
Business intelligence will help the health care provider shape its services for the future. In the here and now, monthly average cash flow has increased by $6 million as a direct result of having information centralized and shared in the EHR system. Multiple people are inputting billing and collection information rather than one single person, which has resulted in accelerating accounts receivables and a 25% increase in billings.
When asked what ultimately unstuck the EHR system? "The common thread is communication. Face to face or by email, we constantly let people know where we stood and how we were managing expectations."
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