Rhapsody Health Solutions Team

HITECH Timelines – Project Management Considerations

February 10, 2010

There have been many discussions taking place on the timing to meet the forthcoming Meaningful Use regulations and incentives. As a reminder, below is a summary view of the three stages for achieving Meaningful Use.

Overview of Meaningful Use Stages

what these stages directly relate to is gaining access to the incentive dollars. below is a chart highlighting the overlay of the stages with the timelines for proving meaningful use. included in this view are suggested project implementation approaches based on when organizations will pursue achieving the regulated guidelines.

implementation approach for meaningful use projects

Timing, as in most things, is critical. Depending on when your organization really begins to pursue the Meaningful Use criteria will drive which project implementation approach is optimal. In this case, optimal is based on two key elements:

  1. Enhancing the ability to meet the stage 1, 2, and 3 criteria in the defined schedule
  2. Gaining the maximum incentive payment in a target year

With this as background, let’s highlight the five different project implementation approaches outlined in the chart above and provide some insights on what each approach may mean to your organization.

Agile. Agile project management encompasses a tight collaborative approach with very short cycle times between projects. Individuals across functions work very closely together within rapid delivery time schedules. The project deliverables are well-defined and manageable, to a certain degree. Agile project teams stay together through all of the project cycles.

One of the key objectives is to put boundaries around project scope in order to go through the complete project cycle within a 4 week or so time schedule. Information flow between the team members is open and honest. A potential challenge with this approach is that it may not work as effectively with larger project scopes. Breaking the project into smaller “chunks” may not be an efficient way to implement larger projects in a productive manner. However, by starting in 2010 to meet Meaningful Use requirements in 2011 and 2012, the project deliverables initially undertaken can be defined around those specific year requirements.

Iterative. As the name suggests, this approach is a cyclical one. It is similar to the agile methodology. This implementation approach usually leverages cross-functional teams who have the responsibility and authority to quickly gather information, implement, and solicit immediate feedback until the requirements are met. It is an active approach in which there is a current iteration plan being worked while the next iteration plan is coming together. The second iteration plan is ready right after the current iteration is completed.

The number of iterations will be determine by the overall time schedule as well as the number of projects being pursued. There may be multiple iterative projects happening at the same time, which feed an overall iterative project plan. If you are getting dizzy from all the iterations, think of this approach as bees buzzing around furiously filling the honeycomb with their hard work.

The advantage to this approach is that you may discover issues earlier in the process and multiple projects can be more effectively handled at the same time. Additional coordination may be required to keep the iterations aligned and moving forward.

Waterfall. Using the waterfall project implementation approach is a sequential completion of various activities. Methodically, each phase –Requirements, Design, Implement, Test, and Production – is very structured, and it is completed prior to moving on to the next phase. It is a more cautious approach and requires more time to complete. The argument for using this approach is that by fully completing each phase, you will save time later in the cycle.

Using this approach involves identifying the various requirements now, and then lining the projects up in the right order to move through complete Meaningful Use achievement. A longer runway of time is needed to deliver effectively. Consequently, if you know that your organization will not be able to implement Stage 1 requirements until 2013, intense planning will be a prerequisite to meet all the requirements during that 3-year window. The project will need to be well defined and mapped out which aligns more appropriately with the waterfall approach.

Big Bang. Big bang approaches to implementation were more popular in Y2K projects. During this time, process re-engineering combined with major systems implementations all happened within one enormous project and within one project schedule. Taking this approach requires many resources – many people and big budgets. Much can be accomplished within a year or two, but multiple elements are crucial, including tight coordination between various teams, well-documented project plans and connection points, and a well-focused – single-focused – team. In this approach, details can be lost in the push to get the overall project completed, and fatigue can set in with the various team members.

Big Bang2. Take everything above, divide the time in half, square the team size, square the risks, and hope it works! The reality is, by this time, unless the scope of what needs to be completed is small, it is better to plan a reasonable implementation and not worry about the incentives. The central point is, if you waited this long to meet the requirements, your concern should be more on avoiding the penalties than realizing the incentives.

Implementing full scale projects on any of these timelines will create many obstacles and challenges. Having a well-thought out implementation approach along with talented people and flexible, adaptable supporting technology will reduce the risk and facilitate your efforts to meet regulation bars set.

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