Author
Mrs Fiona Miles
Health Information Systems Project Manager
Grampians Health Information, Communication and Technology Alliance
PO Box 577
BALLARAT 3350, Victoria
Ph: 5320 6426
Fax: 5320 6475
Email:
CV details
Fiona completed a Bachelor of Health Information Management at LaTrobe University in 1997 and a Graduate Certificate in Business Management at The University of Ballarat in 2001.
Fiona has worked at Ballarat Health Services in various health information management positions including Regional Services, Staff management and Coding and Quality. Fiona was on secondment for 11 months to DHS - Melbourne as a RAPID Field Support Officer, and has been on secondment since January 2004 to the Grampians Health Information Communication and Technology Alliance as a Project Manager. Fiona has been involved with the Victorian HIMAA branch representing both the Education Sub Committee, Mental Health Special Interest Group and Executive.
Abstract
The paper will focus on the role of a Health Information Manager fulfilling the role of a ‘business systems expert’ in Project Management across 12 health services within the Grampians region. The aim of the position is to assist health services with the implementation of IT solutions into their service and to review business processes by providing strategic thought and analysis and assisting in the coordination of change management. For some projects joint contractual arrangements have been negotiated providing financial advantages for health services.
The health services vary in size greatly from the large regional Ballarat Health Services to the small Rainbow campus of West Wimmera Health Service. To provide some indication of the variety of health services, an overview of the Grampians Health Information Communication and Technology Alliance (GHICTA) will be provided.
The paper will include a detailed review of the skill requirements of the project manager to fulfil such a role, and the advantages of having a Health Information Manager in such a position. The paper will also describe the challenges of working remotely to implement administrative and clinical projects and the advantages of centralised coordination across a large region. The presentation will focus on some of the strategies used at the health services to minimise the disruption to services and maximise the benefits of the various IT solutions.
Several of the projects implemented across the region will be discussed including the regional roll out of the electronic Birthing Outcome System, computerised Medical Record Tracking, the development of a data warehouse and the consolidation of a Patient Master Index.
IT projects on a Regional Scale
Objectives
The paper aims to provide an understanding of the project manager role across a number of health services within the Grampians Alliance. The project manager’s direct involvement with the health services is highlighted in addressing key projects that have been rolled out over the past 18 months. In reviewing these projects, the challenges, advantages and change management issues are considered.
Background
The Grampians Health Information and Communications Technology Alliance (GHICTA) is a regional body established between twelve Health Services and three Primary Care Partnerships from the Grampians, Pyrenees, Central Highlands, East and West Wimmera Regions. GHICTA is responsible for developed, implementing, sustaining and reviewing a Regional ‘whole of health’ Information and Communication Technology Strategy to the benefits of its members.
GHICTA covers a large section of Victoria with the GHICTA offices being based in Ballarat. Travelling requirements are sometime strenuous to visit health services. The potential to be travelling three hours for a two-hour meeting is not uncommon. The health services that are part of GHICTA vary greatly in site. The largest health service is Ballarat Health Services, whilst the smallest is the Rainbow campus of West Wimmera Health Services.
To assist in fulfilling components of the Information and Communication Technology Strategy for Health Services within the Grampians Alliance, GHICTA appointed a Health Information Systems Project Manager for an 18-month period. During this time a large amount of work has been carried out to build on developing existing communication channels and working relationships not only with the health services, but other companies that provide a service to the health services. This includes IT consultants and external software suppliers. In conjunction there has been the roll out of systems to health services within the alliance.
The Project Manager
The project manager performs a key role in the coordination, maintenance and development of regional information systems, standards, business practices and application of technology. In fulfilling the roll of a ‘business systems expert’ the project manager liaises closely with healthcare workers, managers, IT consultants and administrators and also external vendors.
One of the most rewarding components of the position is the ability to be able to provide a health service with an IT solution that has been wanted and needed for some time, and in the majority of cases the ‘want’ or ‘need’ occurs due to the health service not having sufficient resources. These resources are a combination of financial, people and skill set. Being able to assess what is important for each individual health service is important, eliminating size and complexity. The health service needs to be able to provide an efficient service and to be able to streamline processes. More often than not it is identified that this involves an IT solution.
To be able to do project management in a proficient way a number of skills are required. The project manager must think strategically and identify whether sometimes some processes are better left as they are. The size of the health service needs to be taken into perspective, as does the solution that is going to be implemented. Being able to plan and manage a project is vital. The project manager needs to be organised. As coordination of projects happens from a centralised office the need to provide information to key people in an efficient manner through a number of mechanisms whether email, telephone, videoconferencing or site visits is essential. Excellent communication skills are the key, ensuring that communication is at all levels of the organization. Being able to manager multiple projects at any given point is a difficult but essential requirement. The need to keep two steps ahead and forward plan isimportant. A key to successful project management is that it is from start to finish; there is the need for follow up, evaluation and providing ongoing education and once implemented the project does not finish. Being able to problem solve is a key function as in many cases the health service personnel will be looking to the project manager for direction. Listening to what the health service wants as compared to what they need should be addressed, and in conjunction you need to be receptive to their current procedures. Importantly there may always be better ways of performing tasks and it is the way in which you relay this that will determine the success. It is important to avoid and manage risk as best you can and this will involve the development of a risk management plan. Having experience with application of technology is very useful, as is having the ability to be innovative in this ever-changing environment.
There are many advantages to having a Health Information Manager involved in project management. Firstly HIMs have a good knowledge and understanding of a broad cross-section of processes, whether clinical, administrative or information technology. There is an understanding of how things fit together. HIMs also have an understanding of both internal and external requirements for data collection, reporting and documentation. In the projects that have been rolled out into the Grampians alliance, this knowledge has allowed for consistent code set development and reporting to external agencies. Of particular benefit to GHICTA was the already existing knowledge and relationships of the project manager of the health services, and the clinical, administrative staff and IT staff within. Much of the preliminary work in building a working relationship from scratch was already underway, which then allowed the projects to move quicker. Trust, confidence and acceptance had already been received from the health service. Clinical terminology is of importance particularly when implementing a clinical application. Clinical staff feel a lot more comfortable when you are able to talk with them, and understand what they are talking about. HIMs are known for their ability to document. This is necessary when developing policies and procedures, training manuals and also from the regional approach with the coordination of meetings. Record management skills have been essential, as some of the projects have involved a review or implementation of medical record management policies and procedures. One key thing to remember, do not forget Edna Huffman (no matter what version you have!)
The Projects
Data Warehouse Project
The development of a data warehouse has allowed for timely extraction of patient master index (PMI) and episodic data from the Patient Management System. Thus far this has been rolled out to health services that have implemented the Birthing Outcome System (BOS) and the Referral Information Management System (RIMS). Roll out has been streamlined as the majority of health services within the alliance all use the Patient Management System hence configuration has been consistent between health services. An extraction is taken from the Patient Management System every 6 minutes and updates the warehouse. This in turn updates the product that utilises the warehouse for patient related data.
For many health services the warehouse has provided a solution for the development of a back up of the Patient Management System. A reporting package has been utilised to allow health services to stop the creation of manual PMI cards and develop an accessible PMI in situations were the Patient Management System may be not available. With the development of the data warehouse, interfacing becomes independent of the Patient Management System.
Birthing Outcome System (BOS)
Seven health services throughout the alliance have embarked on the implementation of BOS. The importance of having key people at the health service level is very important as they are going to be able to:
- Assist you with the implementation
- Promote the implementation throughout the health service
- Be accessible and reliable
- Work at the ground level in preparing the health service, as the project manager is not on site all the time
GHICTA financially supported the implementation of BOS for the health services involved with the purchase of a regional license as well as tablet devices and coloured printers. Without the support of GHICTA some of the smaller health services in the alliance that have obstetric services would not have been able to implement BOS. GHICTA has been able to assist in providing a solution that all health services have seen the benefit of.
With the implementation of BOS, GHICTA saw the opportunity to take the electronic system to the next level and trial the use of tablet devices using remote access technology. A trial was held for a four-week period and following the success, all health services then invested in the tablet device. The benefits of a tablet device include the flexibility to be able to allow the user to enter data at the point of care. Currently the health services are using the devices in the birthing suites, operating rooms and by the patient bedside.
Medical Record Tracking (MRT)
Four health services throughout the alliance have implemented the Medical Record Tracking module of the Patient Management System currently being used in majority of health services within the alliance. The Patient Management System was implemented from 1997 to 2000 in health services and since then has been stagnant in terms of implementing other modules available.
One area that health services could see was deficient and that a solution needed to be sought, was that of removing manual tracking and implementing electronic tracking. It was expected that a significant impact was going to be received by all health services in a short amount of time. The impact received was going to be in having a reduction in time of locating a medical record or other document by improving the accuracy of the locations, and also by having the ability to track other documents that in the past did not have a manual tracking system attached.
A regional approach was taken for implementing MRT into the four health services that allowed for:
- Regular meetings to discuss configuration and set up with involvement of key
- Development of communication channels between personnel from each health service
- Streamlining of work processes for training and rollout
- The development of consistent work practice training manuals and procedures
In conjunction with a regional approach, GHICTA was able to financially support the implementation of MRT by negotiating a regional contract with the Patient Management System supplier for joint purchase of the module.
PMI Consolidation
The PMI consolidation involved the coordination of five campuses at the one health service in merging five separate PMIs that existed. There was months of planning and preparation involved in merging the PMIs and many issues to consider. Should the UR number be 6 digits long, what medical record filing system should be used, was colour coding should be implemented, and the list goes on. After planning for almost 12 month the merge occurred with minimal disruption.
Along with the PMI merge encouraged the review of other medical record and administrative procedures. The review included stopping the creation of PMI cards (assisted by the data warehouse project), changing the manual census to computerised, developing a consistent medical record filing system throughout the five campuses and development of a policy and procedure for culling and destruction of medical records.
Challenges
With the GHICTA offices being based in Ballarat, many challenges have been faced with implementing projects on a regional basis and the associated distances between the health services. Extensive travel is required throughout the Grampians region, and it is always best to try to coordinate site visits. Remote access can be very difficult when trying to explain what staff need to do when resolving a problem over the telephone. Mechanisms are currently being put in place to provide remote access technology to assist with this.
Not being part of the organization structure for a health service is also challenging. Sometimes you are not aware of issues that may be occurring within the organization that may affect the success of the project, there are political relationships within all organizations, you do not have any real authority and mostly, the time spent to gain respect, trust and confidence from staff is consuming. Being able to maintain the enthusiasm of staff when you are not part of the organization is a challenge. The need to be onsite regularly and become a familiar face is important; you need to feel like you are part of the organization.
Making regular contact with key people of the organization is important as is identifying key people within the organization to assist with encouraging staff and providing the motivation to keep the project moving ahead. You are also able to rely on them to disseminate information throughout the health service. It is difficult to monitor whether actions are completed, hence the need for these key people and also the development of working groups. Division of responsibility and knowledge is an area that you need to monitor closely ensuring that you are able to transfer skills and knowledge to the right people. You need to be able to create a balance of support versus spoon-feeding.
Clinical challenges also exist when implementing IT solutions. There is always overriding clinical responsibility where the patient will come first, hence the need to be flexible and fit in with clinical staff schedules. In conjunction with this is the need to keep meeting times to a minimum, and also creating a test system so that staff can ‘play’ with the system without having to leave the clinical area. It is essential to identify at a very early stage those clinical staff that you will need to provide extra support, encouragement and monitoring when implementing the system. It is important not to use technical language, and remind staff that they are not expected to be experts. It is also better to let them drive the PC rather than you demonstrating what they need to do.
Advantages of central coordination
When implementing the same system throughout a region, central coordination allows for consistent configuration. This includes code sets, screen designs, forms and reports. With the implementation of BOS, the Grampians region is using the same electronic discharge summary providing information for inter-hospital transfers.
Being able to coordinate training between health services encourages discussion, networking and sharing of ideas and knowledge. Economic use of expert resources including HIM, IT and clinical and administrative staff provides cost benefits and allows for central liaison with key people.