Managing the Increase in ARRA-Focused Projects “A Real Success Story with the Bayfront PMO Workbook”

November 2011

Introductions• Paul A. Capello, PMP

• Manager of Project, Program and Portfolio Office

• Bayfront Health Systems, St. Petersburg, Florida

Session Objectives• How using a PMO Workbook will make a difference

in the Meaningful Use-ARRA projects focused future.Documentation, Documentation, Documentation!

– Project Scope.– Project Change.– Project Risk.– Project Issues.– Etc…….

• Bayfront Project Portfolio Success Metrics.“You can’t argue with Success”

Bayfront Health Systems founded in 1968, consists of the facilities listed below:• Bayfront Medical Center (BMC) St. Petersburg - CPOE

• Bayfront Medical Plaza St. Petersburg –Live EHR

• Bayfront Convenient Care Clinics –Throughout Pinellas County(7 Locations) – Live EHR

• Bayfront Family Health Center St. Petersburg –Live EHR

• BayFlite- Largest Helicopter Fleet in the Southeast US.

What is a Project At Bayfront Technology Services?

• A Bayfront Project is a “temporary” endeavor (consisting of greater than 40 hours of work) undertaken to create a unique product, service or result, i.e., install new technology, upgrade or change existing technology.

• Projects are quantified by more than 15K in Capital Costs and need approval from the Bayfront Technology Steering Committee.

Complete Proposed

Project Profile

Document

Present Proposed Project Profile Document to Technology Steering

Committee for Approval

Approved?

If Total Cost over $15,000 Complete

SOC

NoEnd

Yes

SOC Approved by Sr. Mgmt? NoEnd

Select Project Lead and Interview Project Sponsor to Complete

appropriate sections of Project Handbook

Complete Needs Assessment

Yes

Project Kick-Off

Create Project Plan

Prioritize Project with Technology Steering Committee

BHS Project Process

New Project Work Breakdown Structure

1. P.P.P.D. Approval Process2. Project Kickoff3. Define Software Resources4. Define Hardware Requirements5. Define Network Configuration(If applicable)6. Review Domain(Environments) Strategy7. Update System Documentation8. Testing, Testing and More Testing9. On Going Training10. Production Implementation11. CLOSE-DOWN PROCESS BEGINS

Cerner HNA MillenniumAdmitting/Reg/Scheduling

CareNet

Power Chart/Orders Documentation

RadNet (Radiology)

PACS(Radiology)

PathNet (Laboratory)

PharmNet (Pharmacy)

FirstNet (ER)

INet (Intensive Care)

PowerNote (Physicians)

ProFile (Medical Records)

ProFit (Business Office)

CPDI(Document Imaging)

INBOX/Message Center

Sodexho (Dietary)ADTs

from Open Engine,

Cerner Open

Engine

Cerner Open Engine (ADTs out/

Charges in)

ECIN (Discharge Planning) -

ADTs

McKesson (Medication Drug

Boxes and Robot) - ADTs

and Orders

ESI (Materials Management) -

ADTs

ParExcellence (Supplies) -

ADTs

IMPAC (Cancer Care)

- ADTs

PassPort (Eligibiity from Scheduling) ***

PowerScribe/Cerner

Radiology Dictation Orders & Results

3M Coding and Reimbursement (to and from ProFile)

E-Premis

Patient Refunds to

AP

Infinium Materials Mgt/

AP

ParExcellence Supply

Charges

IMPAC Cancer Care Charges

IMACS Managed Care

Landmark Transcription

(Inbound to Power Chart)

Infinium GL (Revenue)

Collection Agencies

(Batch HL7 Messages)

Payors (NEIC, BlueCross, Medicare, Medicaid)

GE Muse Orders & Results

McKesson Drug Carts/

Robot Charges

Sunquest Blood Bank

Charges

3M Coding APC Grouper (from ProFile to ProFit) -

Batch Interface

5010-837

Statement to Express Bill

Philips Xcelera Orders & Results

Philips Xper Cardiac

Optimal Radiology Reports

Pre Collection Agencies

GE QS Fetal

Monitoring

PMO WORKBOOK HISTORY??• In February 2004, Bayfront went Live with Cerner from 7.8

to 2004.1(Phase 2 – 12 Nets including ProFit!).• Subsequently, a formal PMO Methodology was introduced

which included the first rendition of the PMO Workbook.(In its 4 iteration.)

• Cerner subsequent upgrades include:– 2005.02.46– 2005.02.54– 2007.12– 2007.19.03– 2007-19.15– 2012 –April 2012

ORGANIZATIONAL COMMITTMENT

One of the key foundations of Bayfront’s Methodology was establishing an effective Project Structure. Success requires the Bayfront's Leadership’s commitment to thorough planning and regular review and approval of Projects.

An experienced, knowledgeable and committed Project organization must be assembled and certain members designated as leaders.

Steering Committee /Governance Council

The purpose of the Steering Committee is the following:– Provide Executive Direction to the Project Team. – Verify Projects are meeting Bayfront's Strategic Business

objectives.– Resolve Issues that are beyond the authority of the

Project Team. – Additionally, The Steering Committee will verify the

project deliverables meet the business requirements of Bayfront. These meetings are conducted at key project milestone dates with the results communicated to the Project Team.

PROJECT ADMINISTRATION

• Project monitoring and control procedures document the process and mechanisms for tracking the project. Proper monitoring of the project is dependent upon excellent communication throughout the project organization. This communication is the responsibility of the entire team, but

The Project Manager or Project Lead is the #1 “Go To Resource” on Communication.

Project Manager or Project Lead

Both BMC and Vendor project managers will be responsible for the following: – Provide full-time project management as detailed

in the contract. – Monitoring project plans and implementation

schedules to ensure upcoming tasks are identified and communicated to team members.

– Making task assignments and ensure task completion.

– Identifying and documenting potential problems or issues and ensuring these are communicated to the Project Director and Project Management Team.

– Reporting progress to the Project Director and other Team Leaders in status report meetings.

– Maintain the official project documentation.

Status Report for Week Status Report

Customer:

Project: For period: Starting: Ending:

Achievements This Period:

Planned Next Period:

Scope Status:

Budget Status: Original budgeted costs: Expected final costs:

Schedule Status: Planned completion: Expected completion:

Major Issues:

PROJECT DELIVERABLESThe key deliverables for the project are as follows:• Visualize the final product

Build a visual of the implemented application by posing the following questions to the team:– When the system is in place, what will it look like to you? – What does the application have to do to meet your critical

business requirements? – How will information get into the system? – How will that information be updated, used, modified and

distributed? – What technical capabilities are essential for your

environment? – Will the system have to interact and/or integrate with other

systems? If so, how will that occur? • Milestones

– *Key deliverables

PROJECT WORK PLAN• The project work plan is used to control the

progress of the project on a day-to-day basis. • The project work plan contains the detailed

activities and tasks required to develop the project deliverables, to monitor progress compared to plan, and to assign tasks to project team members.

• The overall project work plan is updated weekly based on the accomplishments communicated at the project status review meetings, documented in project status reports, and discussion with project team members.

Meetings

Project status review meetings serve to convey status, identify issues, and detect scope changes to the overall project. Additionally, these meetings serve as a tool to record and measure team progress and performance and ensure project objectives are being met. These meetings are conducted on a weekly or bi-weekly basis and typically include the Project Team.

MeetingsThe following agenda will be used:

• Brief summary of project to date• Review of open issues• Discussion of previous week’s tasks and

accomplishments• Review status and update project work plan• Identify new issues, provide resolutions, or

record on the project issue and project log forms and assign as appropriate

• Assign new tasks and action items for the next week

• The results of the meeting are summarized, activities recorded and minutes distributed to the Project Management Team. Team Leaders are responsible for communicating the results of these meetings to their sub-teams

Bayfront Technology Services Meeting Minutes Example

Agenda Item Discussion Action Items Owner Scheduled End Date

Deactivate "beginning of year" hard code in programs:CUG100EX, CUG110EX, CUG140EX.

Some temporary code exists in these programs that need to be activated for the first run of the year, and then deactivated.

Deactivate "beginning of year" hard code in programs:CUG100EX, CUG110EX, CUG140EX.

Melanie McKee

3/12/2011

Personnel transaction custom programs needed to be modified to submit the self-service file update after the HR file updates so that self-service would pick up the group associated with the new position. Programs to change are:CUGTRTR, CUGTRDM, CUGTRHI, CUGTRPR, CUGTRRH, CUGTRTR

Not a critical item, but one that should be cleaned up...I have noticed several people in the HR group of self service that are not and never have been in HR. Additionally, that HR group has traditionally been limited to a very small group of people. Not sure why it has been expanded to include people from Bearly Sick etc.

Personnel transaction custom programs needed to be modified to submit the self-service file update after the HR file updates so that self-service would pick up the group associated with the new position. Programs to change are:CUGTRTR, CUGTRDM, CUGTRHI, CUGTRPR, CUGTRRH, CUGTRTR

Melanie McKee

2/26/2011

MEETING: Bayfront Change Management MeetingDATE/PLACE/TIME: Monday March 22, 2011 Mangrove Conference room 1:00 pmATTENDEES: Paul Capello, Jennifer Greenman, Tony Curtis, Herman Gilyard, Denise Murphy, Mike Musallam, Denise Rafferty, Marge Slater, Melanie McKee, Heather Morrison, Jason Barth, Helen Bruns, Dave Leclaire

Project Documentation

Project Documentation is any material related to the project that provides an audit of the project. This includes the following:

– Formal Deliverables identified in the Project Work Plan– Project Status reports– Project and Steering Committee reports– Supporting Notes and Memos– Key Decisions forms– Meeting Minutes– Other informal documentation kept by Project Team

members to support their work and deliverables.

Project DocumentationProject Documentation may be maintained in

electronic form in designated project file directories, with those project documents requiring approval printed for distribution and signature. Project Leads will maintain team documentation, such as meeting minutes, in electronic and/or paper form and supply key deliverables to the Project Director when completed.

RISK MANAGEMENT• Risk Management is the process of identifying areas of risk that

could negatively impact the success of the project and proactively managing those areas. Risk is analyzed during the initial stages of the project to lay the foundation for success and on an ongoing basis during the project.

• Risk assessments are the means used to analyze risk. They highlight common areas of risk with the intent of identifying and controlling the risk. After high-risk areas are identified, risk control processes are selected and implemented.

• The following risk assessment describes potential high-risk areas of the project and documents the mechanisms established to control these areas.

Risk Target Control Procedures

Business

Vendor involvement not at a level to insure success

Vendor involvement at a level to insure success

Vendor involvement not at a level to insure success:Implement regular status reportingDetailed project managementTry to expand vendor involvementDevelop a very detailed project planInclude frequent quality reviews

Project Environment

New system hardware required No new system hardware required New system hardware required:Gain access to technical specialists Integrate delivery and installation into project schedule Purchase proven hardware

SECURITY / CONFIDENTIALITY• Data in all its forms (electronic, paper, or other), and throughout its life cycle

(creation, entry, storage, processing and disposal) will be protected from unauthorized access, modification, destruction and disclosure, whether accidental or intentional, at Bayfront Health System.

• User Access Controls– One of the key ingredients of information protection is user access

controls over who can access the information and how they can access it. To ensure appropriate levels of access, security measures will be instituted for this project.

• Security will be controlled by menu design as well as security levels attached to individual items.– A complete analysis of existing application access and security will be

done and adjustments made to ensure all existing users have access specific to their job requirements.

• Password Management– Passwords are not displayed when entered.

• Employee Awareness Programs• Monitoring/Reporting

Change ManagementChange Management is the process of managing changes to

previously agreed-upon areas of the project. – Changes can affect many areas: the project resources, the

project deliverables, the cost and time frame in which objectives must be achieved and even the project priority.

– Change will be viewed positively as long as its purpose is to ensure Bayfront's business needs are met.

– Change Management documentation preserves the integrity of the project definition document, provides a mechanism for handling change requests, and provides a means for retaining historical change/issue information to enhance future project management efforts.

Change Management• The following process is followed when a change to the

schedule, budget, or scope of the project is required.• Identify the Change: Determine if the change is within or

outside the scope of the project.• Record the Request: Complete the Change Request Form and

submit to the Project Manager.• Evaluate the Request: The Project Team will review the

proposed change and make a decision to approve, disapprove, or alter the change request. The Steering Committee will be contacted if a decision requires approval at a higher level.

• Implement the Change: If it is determined the change should be incorporated into the project, the Project Work Plan will be updated to reflect the change in tasks, resource requirements, deliverables and/or timeframes.

Scope Change Request Form

Customer:

Project:

Requested by:

Description of the Change:

Justification for the Change:

Project Impacts (Project Manager Use Only)

Budget and Schedule Impacts:(Project Manager Use Only)

New Project Completion Date: Additional Project Costs:

Date: Resolution Required by:

Signed (Project Manager):

Resolution: (Customer Use Only)

Approved Rejected Date:

Signed:

Name and Title:

Issue Management

An Issue is anything that arises which, if left unresolved, could delay or have an impact on the success of the project.

• All Issues are documented on the Project Issue Form. Each issue is prioritized, assigned an owner, and documented on the Project Issue Log. Issues the Project Team is unable to resolve are escalated to the Project Team Management for resolution or submission to the Steering Committee for resolution. Outstanding issues are reviewed at the project status review meeting.

• Any Issues that result in an increase in the project budget, time estimates, or scope must be documented on the Project Issue Form.

Issue Escalation Guidelines:Level I - Issues are resolved and documented by the Project Team and/or

Work Team. Decision deadline: up to one (1) week.

Level II - Issues which cannot be resolved at the Project Team Management level are submitted to the Project Director for review with the Project Team Management. Decision deadline: up to one (1) week.

Level III - Issues which cannot be resolved at the Project Team Management level, or which are so sensitive as to require Executive approval, will be submitted to the Steering Committee, for resolution. Decision deadline: up to fourteen (14) days.

Level IV - Issues which cannot be resolved at the Steering Committee level are submitted to the Project Sponsor for review with senior management. In addition, an issue can be escalated directly to Level IV based on issue criticality.

        BAYFRONT MEDICAL CENTER2007.19.03 TESTING ISSUES

 

SR# CWX or SWX?

DATE APP 2007.19.03 TESTING ISSUES- MOCK HPUX

Reported by

Daily Update

  CWX     UPTIME (package installation)   March 22nd to March 26th

        STEPS BEFORE GO-LIVE    

  CWX- Mo, Tony

  Fat clientsUpdate \\nas\p5102 with new code warehouse.

  On your NAS share if you have no Space issues then, rename your current P5102 to P5102_VMS. Re-sync the DBMIG (copy from RRD02 to NAS) once done synching, create a new copy of DBMIG folder and rename it to P5102. Use that one for Prod Fat client setup.

  CWX- Mo   Fat clientsSend new batch file for fat clients including setup.ini and group files

  3-24 Mo copied to RRD02 DBMIG

  BMC   Fat clientsDavid and Leonard will test upgrading fat clients before upgrade

   

  Mo and Tony     BMCCitrix03- CPDI needs setup?    

  Desktop   PACS Upgrade PACS Viewing Stations for Citrix version 11.0

  Almost done

PROJECT PROFILE DOCUMENT

Name Specialty Position

PART I—PROFILE IDENTIFICATION AND REGISTRATION1.Profile/Project Title2.Profile Control Number

The PMO will register the PPP in the project control system.1.Profile Preparation Team

1.Profile Completion Date2.Business/Clinical Case

Refer to an early stage SOCStrategic Direction or Action StepsBudgeted for Capital Year (Yes or No)

PART II—PROPOSED PROJECT DESCRIPTION AND OUTLINE

– Project Scope– Project Objectives– Project Background/Linkage– Project Assumptions– Project Classification– Recommended Project Start and Completion

Dates

PART III—PROPOSED PROJECT MANAGEMENT PLAN Project Manager

Project Management Team

Name Specialty Position

1.Project PhasingProject Phase-Workload Estimate Table

PhaseWork

Package/ActivityRecommended

ScheduleRecommended

ResourceEstimated

Cost

PART IV—PROJECT EVALUATION AND VALIDATION

• 4.1 Project Objectives

• 4.2 Project Risks

• 4.3 Project Structure

• 4.4 Hardware Requirements (If applicable)

PROJECT TEAM REVIEW AND APPROVAL FORM

• Document/Deliverable: Project Workbook

Date Presented:

• Paul Capello, PMO Date_____________

• Jennifer Greenman , CIO Date_____________

Project Success StatisticsIn 2011, the Standish Group reported the following

Project Statistics:• In 2010, 37% of projects completed on-time and on-

budget. (Bayfront Success Rate is 95% since 2004)

• In 2008, 32% of projects completed on-time and on-budget.

• In 2004, 28% of projects completed on-time and on-budget.

Bayfront Project Portfolio 2011Project Name

Bayfront Technology Services and Clinical Transformation Projects Bayfront Technology ServicesMessage CenterMedication By History(Meaningful Use)Power Chart Enhanced View(Meaningful Use)Cerner Upgrade to 2007.19.15Ansos Staffing(Phase 1)Vocera Nursing CommunicationCPDI Lab(Micro and AP)INFOR(Materials Mgt, Accounts Payable and Purchasing)Sodexo/Health Touch Dietary Office SoftwareCPOE -Tracking List(Meaningful Use) - ED -Phase 1NextGen Ambulatory EMR for FHC(Meaningful Use)Philips XPER(CPOE) -eMAR/Provider Order Entry(Meaningful Use) - ED -Phase 2AthenaAthena Practice Management - Cardio - Phase 1Athena Practice Management - Ortho - Phase 2Athena Practice Management - Cardio - Phase 2BayScript Pharmacy - Retail RXCPOE - ED Doc(Meaningful Use) - ED -Phase 3MetaHealthClinical Document Generator-CDG-CCD(Meaningful Use)Rehab Evaluation and Treatment Form Development(Meaningful Use)Health SentryClinical Reporting XR-MRP(Meaningful Use)Conversion to 5010 837 project

Clinical TransformationCare Focus/ Mercury MD(Rx-Phase 1)DVT( Deep Vein Thrombosis)(Meaningful Use)PACU Nursing Documentation(BMDI)ED Documentation(Meaningful Use)Depart Process(Meaningful Use)Problem List (Meaningful Use)Smart Pumps

PMO ValueAccording to PM Solutions®, companies that implemented a PMO achieved the following Performance Improvements:

• 31% Decrease in Failed Projects

• 30% Projects Delivered Under Budget

• 19% Projects Delivered ahead of schedule

$567K is the average Cost Savings per Project that a PMO Provides.

Bayfront’s successful PMO is in its 8th year of existence.

Questions & Answers

Contact Information

Name: Paul Capello

Email: Paul.Capello@bayfront.org

Phone: 727-893-6038(O) 727-902-1426(M)