Comprehensive Study Notes on Project Management and Health Informatics Application in Health Informatics

Practical Application of Course Concepts

• The course covers a wide variety of activities used daily in professional health informatics and project management contexts.
• Key practical activities include:
  • Workflow mapping.
  • Design decision-making.
  • Project management (PM).
  • Contracting and vendor selection.

Project Management Certifications and Credentials

• The Project Management Professional (PMP) is a highly respected and sought-after certification in the industry.
• PMP Requirements:
  • The original form requires a specific number of years of validated experience managing projects.
  • Candidates must provide documentation to validate their experience and projects before they are eligible to take the exam.
• Certification Levels:
  • There is a lower-level certification (often referred to as CAPM) for those without enough experience to qualify for the PMP, allowing them to build up to higher credentials.
  • The Program Management Professional (PgMP) was added approximately $10$ years ago for those managing groups of related projects.
• Career Value:
  • PMP certification adds value to health informatics roles.
  • From a compensation perspective, individuals with a PMP often command higher starting salaries because of the higher value they bring to the organization.

Definitions: Projects vs. Programs

• Project Management focus: Managing a temporary endeavor with a defined beginning and end.
• Program Management focus: Managing a group of related projects that may span long periods.
• Program Example: Grady Hospital has had a program running for nearly $3$ years focused on creating patient access, which consists of many smaller projects with definitive start and end dates.
• Methodology: Project management involves preparation (planning) and carrying it out (managing).

Project Management as a Mechanism for Error Reduction

• PM helps keep teams organized and tasks on track, serving as a "taskmaster."
• It prevents the temptation to short-side critical aspects of development, particularly the testing phase.
• Testing issues are considered positive findings because they identify errors before they reach production.
• Use of the Phase Gate approach:
  • This involves identifying specific deliverables at the end of a phase (e.g., the design phase) to validate readiness for the next phase (e.g., the build phase).
  • Sign-offs are required from stakeholders on process flows and business requirements before the build begins.
  • Risk Management: Skipping sign-offs increases the risk that someone will change their mind or a requirement later, causing errors and rework.

Workflow Mapping and Design Phase Details

• Mapping involves understanding current state workflows, identifying inefficiencies, and determining how technology can drive improvements.
• Standard symbols used in mapping (e.g., Visio):
  • Oval: Represents the start of a process.
  • Diamond: Represents a decision tree.
  • Square or Rectangle: Represents actions or steps taken.
• Workflows are divided by user roles (e.g., doctor, scheduler, nurse).
• Analysts often refuse to start building technology before users provide validated sign-offs on these workflow documents.

The Triple Constraints of Project Management

• Project managers must constantly balance three constraints:
  • $1.$ Time.
  • $2.$ Cost.
  • $3.$ Quality.
• Sacrifice Scenarios: If a project is strictly bound by a go-live date, the team may have to sacrifice quality or increase costs (more money) to meet the deadline.

Team Dynamics and the Tuckman Model

• Teams typically follow a predictable four-stage model:
  • Forming: Bringing the team together.
  • Norming: Normalizing interactions.
  • Storming: Tension and conflict arise during this phase as roles and processes are challenged.
  • Performing (Note: Though not explicitly named, the context implies moving toward high functionality).
• Professional project managers must treat every stakeholder equally, regardless of rank (e.g., environmental services staff vs. Chief Marketing Officers), to maintain accountability.

Health Information Management (HIM) and Data Integrity

• HIM professionals focus on regulatory requirements, health information integrity, and data standards.
• CDI (Clinical Documentation Improvement): These professionals check provider documentation for coding discrepancies. If documentation is inadequate to support billing, a CDI request is sent to the provider.
• Key HIM Responsibilities:
  • Owner of coding queries.
  • Data integrity of the system.
  • Master Patient Index (MPI): Ensuring a patient is identified correctly regardless of how their name is spelled.
  • Release of Information (ROI).
• EHR Implementation example: During the Epic implementation at Wellstar, the complexity of HIM's role was crucial for maintaining chart integrity.

Technology Assimilation and Longitudinal Support

• Project success is defined not just by going live, but by assimilation.
• Assimilation timeframe: Literature indicates it takes $7 - 9\,\text{months}$ post-implementation for technology use to be assimilated into a regular routine.
• Georgia State University Study: Dr. Aaron Bird and colleagues studied $9$ to $10$ local physician groups to see how they assimilated EHRs into their routines.
• Value-Based Messaging: Success increases when the technology or problem-solving strategy appeals to the individual values of the users.
• Super Users: Organizations often cannot afford to keep informatics staff on the floor for nine months; therefore, they rely on operational "super users" to support the transition to the new norm.

PMBOK Standards and Project Phases

• The Project Management Institute (PMI) issues certifications based on the PMBOK (Project Management Body of Knowledge).
• Five/Six Core Processes in PMBOK:
  • $1.$ Initiate.
  • $2.$ Plan.
  • $3.$ Execute.
  • $4.$ Control.
  • $5.$ Close.
• Traditional vs. Modern Models: While models vary (Traditional vs. SDLC), the core steps remain: identify problem, plan, put into motion.
• Simplest form for informatics: Infrastructure -> Build -> Test -> Train -> Go-Live.

Change Management and the Change Advisory Board (CAB)

• Configuration Management: Tracking every change made to desktop, network, infrastructure, or application builds.
• "Safe" changes: Operational daily processes that do not require formal change control.
• The Change Advisory Board (CAB) meeting:
  • Meets weekly to review proposed changes.
  • Attendance is mandatory for representatives of various areas (Ambulatory, Network, Desktops, Service Desk, HIM).
  • Process: Review the change, the test result, sign-offs, and the production date. Participants discuss potential disruptions.
• Example: At Grady, a recent CAB reviewed $44$ change items. One was held for further dialogue because the system display would not match physician expectations.

Questions & Discussion

• Question: Why does project management reduce errors?
• Answer: It keeps the group organized. It serves as a taskmaster across phases, ensuring testing is not skipped and that workflows are signed off by end-users to prevent later changes that lead to errors.
• Presentation feedback: The instructor praised the students' focus on "keys to success" and the definition of a successful implementation in their presentation.