IT Project Management @ GW: Analysis of DOD’s Electronic Health Record Initiatives
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Transcript of IT Project Management @ GW: Analysis of DOD’s Electronic Health Record Initiatives
PROJECT
DATE BY26 FEB 2013 MARK SILVERBERGELECTRONIC HEALTH RECORDTHE DEPARTMENT OF DEFENSE’S FAILED
2nd
Project OverviewHISTORY
1988 - DOD begins to acquire an EHR (“Composite Health Care System”)1993 - deployed but lacked many features like integration b/w systems and did not use data standards“perpetuated the reliance on paper-based record”
1997 - new project (CHCS II) with nearly identical scope as 1988 but w/ emphasis on worldwide, 24/7 access, common data standards
KEY INPUTSrequirements were first of many problems; delayed multiple times => delay in creating WBS
COMPONENTSclient-server architecture
client-side appsserver software/hardwareclinical data repository
DELIVERYLike CHCS I, development and implementation contracted out
26 competitive RFPs which resulted in contracts for T&M & FFP11 non-competitive contracts
later found to be unnecessaryby FAR guidelines
2009 - deployment with overwhelming negative feedback
“Intolerable” - congress hearing“slow, difficult to use, unreliable”
“EHR Way Ahead” = CHCS III
ChallengesPOOR PROJECT PLANNING
“comprehensive project management plan was not established” - GAO“poor planning and execution and a failure to appreciate the ‘significant complexity’ of the program” - health industry analyst
REQUIREMENTS GATHERINGEssential to establishing and controlling scopeEnd users of the system were only engaged at the beginning and end of the project lifecycle so when they did provide feedback at the end, it was too late to inform development
LACK OF BUY-IN AND NO FEEDBACK LOOP WITH USERSArmy’s Surgeon General “faced a near mutiny of our healthcareproviders, our doctors, our nurse practitioners, physician assistants”USAF Deputy Surgeon General: “low productivity and providermorale [from] working around the system trying to find new solutions”GAO: “[DOD] stopped measuring user satisfaction levels in July 2007after overall user satisfaction had declined to its lowest pointin more than 2 years.”
What Project Management?Costs were neither minimized nor benefits maximized (or in many cases realized)
$2 BILLION OVER 13 YEARS