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Series 2: Project ManagementAdvanced Project Management for Behavioral Health Electronic Health Records (EHRs)9/2013From the CIHS Video Series Ten Minutes at a Time

Welcome to the SAMHSA-HRSA Center for Integrated Health Solutions video series Ten Minutes at a Time. This is Series 2 on Project Management. Modules 6-10 in this series focuses on advanced project management in the implementation of Behavioral Health EHRs. It can be used by PBHCI grantees to support meeting the HIT-related grant expectations. It can also be used by any Behavioral Health Provider who is interested in integrated primary and behavioral health care, meeting the standards for Meaningful Use, and/or implementing or upgrading an Electronic Health Record System. 1Module 5 Information Technology (IT) Governance OverviewKey TermsLaying the organizational foundationCreating the Information Technology (IT) Governance teamUsing the IT Governance StructureAdditional Resources

This is Module 6: Information Technology (IT) Governance. We will begin by explaining the key terms, then we will illustrate why this type of project requires this special leadership structure. We will explain how you can create and effectively use IT Governance and conclude with additional resources for technical assistance and training. The goal of this module is to provide you with an understanding of how to create the basic organizational infrastructure for initiating and then supporting a successful Electronic Health Record system implementation or upgrade project.

2Key Terms IT Governance: Executive level/Committee structure for aligning the information technology strategy with the organizations business strategy; monitors progress by evaluating achievement of specific milestones; it establishes lines of responsibility and accountability at the onset of the project.

Opportunity Cost: In economic theory, the cost of selecting a course of action in a situation where a choice needs to be made between several mutually exclusive alternatives, given limited resources. It is the value of the best (that is, the most lucrative) alternative course of action that is not chosen.Herman, D., Scalzi, G. and Kropf, R. (2011). IT Governance Best Practices. Retrieved April 2013 from http://www.aspenadvisors.net/results/whitepaper/it-governance-best-practices

IT Governance is a committee structure that integrates the strategic, operational and IT aspects of the organization into a cohesive planning and implementation unit. The IT Governance structure is the vehicle for implementing and managing effective and efficient communication between and among each organizational division, all the way through the organizational structure. In doing so, IT Governance mitigates many types of risk and improves the overall project experience. The model presented here is intended to convey the basic concepts, so that your organization can adapt and modify it to suit your needs.

Opportunity Cost refers to the benefits derived from pursuing one course of action over another. There are benefits and costs associated with implementing or upgrading an EHR, but also with not doing so. One of the first tasks of IT Governance is to affirm a course of action by spelling out the associated Opportunity Costs. 3The IT Governance StructureThree committees, each composed of teams responsible for implementing the projectLeadership from each team meets regularly as a cross-seated Steering Committee

Cross-Seated Steering Committee Representationfrom the Board of Directors

This diagram illustrates the basic nature of the IT Governance structure. There are three areas of responsibility charged with different aspects of the project implementation. They are task-oriented committees that will often form work groups to address specific issues as they emerge. They are led by the organizations decision-makers. This leadership meets as a group in the Cross-Seated Steering Committee. This includes the C-suite of executives, and a representative from the Board of Directors.

The steering committee usually convenes in weekly meetings focused exclusively on the project. Because the complexity of project is often not well-understood during the beginning stages, executive staff may decide to simply include IT Governance activities as an item on the weekly management meeting agenda. But it is actually only effective if IT Governance is a dedicated effort from the very beginning. Lets take a closer look at each committee.4Strategic CommitteeRoleLeads the development of and approves the vision. Approves the budget (so must include regular input from Finance).Sets key IT project priorities through the Project Charter.Endorses IT project principles and policies.Resolves organization-wide strategic IT issues.Establishes accountability.Strategic CommitteeResponsibilityDecisions about IT principles, investment and prioritization based on input from Operational and Technical committees (via the cross-seated Steering Committee)

The Executive Director and also the Chief Financial Officer lead the Strategic Committee. Executive leadership tend to view this as an IT project and then delegate most of the responsibility for implementation to the Chief Information Officer. In fact, it is a strategic planning and implementation initiative that will touch every member of the staff and transform the entire organization. Happily, the executive leaders do not need to acquire information technology expertise. The IT Governance structure leverages the various strengths within the organization. 5Information Technology CommitteeResponsibilityDecisions about IT principles, investment and prioritization based on input from Operational and Strategic committees (via the cross-seated Steering CommitteeInformation Technology CommitteeRoleConfirms project IT hardware, software and staffing requirements. Ensures IT investment is consistent with these requirements and the project goals and objectives.Identifies best practices.Makes recommendations related to implementing policies and regulations in an electronic environment.Identifies IT-related opportunities and maximizes benefits.Ensures that IT resources are used effectively and efficiently.

The organizations Chief Information Officer usually leads the information technology committee. If the organization does not have a CIO, the Chief Financial Officer may take the lead. In general, this is the person who provides the data that executive leadership needs to make decisions about IT resource availability and acquisitions. They usually have authority over the IT planning and budget activities and the organizations IT portfolio. 6Operations CommitteeResponsibilityGuides IT project plan implementation, based on input from Strategic and Technical committees, and Clinical Services LeadershipOperations CommitteeRoleRecommends IT priorities, aligned with strategic direction, technical resources and project time, cost and scope. Implements project planFosters coordination and collaboration.Ensures quality improvement. Establishes measurement criteria for managing risk and auditing performance (time-cost-scope).

The leader of the Operations committee should be the individual charged with overseeing the companys operations, usually the Chief Operating Officer. This role leads the implementation team and manages communication among the various division organizations as it relates to the project, overseeing implementation of the project plan. They need to be in close contact with the CFO and the CIO since all three have a part in monitoring and controlling expenditures and resources. Clinical Leadership is formally represented in the Operations committee, but clinicians should be involved in all three committees and in every stage of planning, especially when it comes to selecting an EHR. 7Cross-Seated Steering CommitteeComprised of leadership from each committee

Meet regularly (recommend once a week) to monitor and control the projectMeet with the expressed purpose of monitoring and controlling the EHR implementation projectOnly the Steering Committee has the authority to modify constraints around Time, Cost and Scope. If one constraint expands, all constraints expand.

Steering Committee

The cross seated Steering Committee has full responsibility for project success or failure. They are empowered to make adjustments to the Project Plan since they are responsible for the project outcome. They ensure the project is adequately financed and supported. There is always competition for internal resources, so this committee must ensure the project has a high profile in the organization. Everyone on this committee must understand that contributing to any one of the three project triple constraints of Time, Cost and Scope means the other two must expand in proportion, or else overall quality will suffer. This committee carefully considers any project modifications to scope before approving them (See Module 2 for more discussion of Time, Cost and Scope). 8Initial TasksSeat the IT Governance Steering Committee, selecting the directors/managers from information technology, operations and administration for this role, to plan and execute the initial tasks The Project Charter and Statement of Work.

Use Project Planning guidance and templates available through Modules 1-5

Ensure funding for discovery phase of project start-up this should be an amount sufficient to bring the organization to the point of selecting an EHR business

Identify competing internal projects - ensure that this project has high level, visible executive leadership support in the organization

The board and the executive leadership seat the IT Governance steering committee. Once this is formed, the initial tasks are to define the nature of the project and how it supports the agency goals and objectives in terms of the overall business plan and system of care. The formal documents for this are the Project Charter and Statement of Work, discussed in Module 1. Either new staff will need to be hired, some responsibilities will need to be reduced, or probably the agency will have to apply a strategy that is a combination of both. This requires a high-level but realistic financial plan for managing resources over the next two years and a Change Management plan, discussed in Module 5. Module 7 on the Systems Development Life Cycle provides some guidance around what to expect over the life of the EHR implementation or upgrade project. 9SummaryThe IT Governance Structure is the vehicle for ensuring effectuve and efficient use of IT it can be used for planning and implementing Meaningful Use if an EHR system is already in place

The Executive Leadership must visibly support the project along with the IT Governance committees, acknowledging the Opportunity Cost and necessary investment of organizational resources

The IT Governance Structure must be actively used, with regular meetings conducted as their own activity. Committee leaders must be empowered to identify resources and manage their budgets

In summary, the first step is to establish the Steering Committee for IT Governance, and develop the Project Charter and Statement of Work, using the systems development life cycle as a high-level guide. The individual committees and the Steering Committee should identify a meeting schedule that is dedicated to the project. Deep understanding about information technology is not a requirement for each member of the Steering Committee. In fact, it is more helpful to consider this as a project the requires executive leadership and engagement, because it impacts every line of business in the organization. Only executive level leadership has the authority to fully manage and control the project.

10We Have Solutions for Integrating Primary and Behavioral Healthcare

Contact CIHS for all types of primary and behavioral health care integration technical assistance and training needs

1701 K Street NW, Ste 400 Washington DC 20006

Web: www.integration.samhsa.govEmail:integration@thenationalcouncil.orgPhone:202-684-7457

Prepared and presented by Colleen ODonnell, MSW, PMP, CHTS-IM for the Center for Integrated Health Solutions

Our thanks go to SAMHSA and to HRSA for providing support to the Center for Integrated Health Solutions (CIHS) for this and many other forms of training and technical assistance related to the integration of primary and behavioral health care. Please visit our web site at www.integration.samhsa.gov, email us at integration@thenationalcouncil.org, or just pick up the phone and give us a call at 202-684-7457.

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