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Project Charter
Computerized Provider Order Entry (CPOE)

Project Name: Project Sponsor: Program Champion: Program Manager: Project Manager: Document Author: File Name: Last Modified Date:

Computerized Provider Order Entry (CPOE) Ann Jones, VP External Affairs Dwane McGowan, CNO Matthew Mabalot, CIO Christina McClenaghan, CFO CPOE Steering Committee (joint effort) Computerized Provider Order Entry (CPOE) 10/6/2013 8:12:00 PM

Document Revision History

Date 3/1/13 3/12/13 3/21/13 3/26/13 Version 1.0 2.0 3.0 4.0 Description/Changes Original Text Update Update Update Author Christina McClenaghan Dwayne McGowan Christina McClenaghan Christina McClenaghan

Table of Contents
1 2 Foreword ................................................................................... Error! Bookmark not defined. Business Requirements ............................................................. Error! Bookmark not defined. 2.1 2.2 2.3 2.4 2.5 3 Background ...................................................................... Error! Bookmark not defined. Project Overview .............................................................. Error! Bookmark not defined. Project Objectives ........................................................................................................... 5 Value Provided to Customers ......................................................................................... 6 Business Risks.................................................................................................................. 6

Vision of the Solution ..................................................................................................... 7 3.1 3.2 3.3 3.4 Vision Statement ............................................................................................................. 7 Major Features ................................................................................................................ 7 Assumptions and Dependencies ..................................................................................... 8 Related Projects .............................................................................................................. 9

Scope and Limitations .................................................................................................... 9 4.1 4.2 4.3 Scope of Initial Release ................................................................................................... 9 Scope of Subsequent Releases ..................................................................................... 10 Out of Scope.................................................................................................................. 10

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Project Success Factors ................................................................................................ 11 Budget Highlights ......................................................................................................... 11 Timeline....................................................................................................................... 12 Project Organization .................................................................................................... 13 Project Management Strategies .......................................................................................... 14 8.1 8.2 8.3 8.4 8.5 8.6 Project Meetings ........................................................................................................... 14 Issue Management........................................................................................................ 14 Scope Change Management ......................................................................................... 14 Training Strategy ........................................................................................................... 14 Documentation Development Strategy ........................................................................ 15 Project Work Paper Organization and Coordination .................................................... 15

Foreword
The purpose of the Project Charter is to document what the Project Team is committed to deliver. The Project Charter specifies the project timeline, resources, and standards for implementation. The Project Charter is the foundation of the project, and is used for managing the expectations of the project stakeholders. The Project Charter serves as a statement of formal commitment between Business Sponsors, Steering Committees, the Project Manager, and the Project Team. It is the professional responsibility of the project members to treat this agreement seriously and to meet their commitment to the Project Charter.

Business Requirements
Background
Midwest Health Care Group (MHCG) has a history of serving the community through the strength of teaching and research relationships with Midwest Medical College and Midwest Nursing College that dates back to 1914. MHCG not only consists of a network of 16 primary care clinics, but also a multihospital with Centers of Excellence for Cardiology, Oncology, Womens Health, Behavioral Health, Neuro Sciences and Orthopedics. The organization takes great pride in partnering with the community to create a strong network of care for our aging population and in the mid-1960s began developing Senior Communities for Independent and Assisted Living and in the 1970s expanded on this with the building of a long-term care facility; Home Care and Hospice programs were added in the 1980s. In 1988 MHCG engaged in a joint venture with another regional provider to bring the first accredited Nursing Homes adding to the already exemplary services that we have been able to provide to the disabled and aging populations within the community.

4 Currently the Information Services team handles the IT for the whole of the integrated delivery network (IDN) that is the Midwest Health Care Group as well as serving as the Information Services (IS) team for another regional hospital system in the area. MHCG has also implemented Storage as a Service (Saas) software delivery method that provides access to the systems software and functions as a remote web-based service for Midwestern Independent Physicians Practices, allowing the IPA to lease storage. MHCG also handles data backup and transmission services for the IPA. Reimbursement to MHCG is determined by the amount of storage space used by the physicians group. Recent growth in information technology capabilities and opportunities for the group expansion in the community have brought the idea of Clinical Provider Order Entry (CPOE) to the forefront of potential technology projects over the next 2-3 year timeframe. The requirement to implement CPOE as a core measure under Stage II of meaningful use compliance in order to continue receiving federal reimbursements for Medicare and Medicaid patients is a major consideration in moving forward. The imposition of penalties for failure to comply should also be a consideration. Adopting and implementing a CPOE system to complement the existing MHCG electronic health record (EHR) system makes sense from an economic and technical standpoint, allowing the group to maintain its position as a leader in health care.

Project Overview
Midwest Health Care Group will benefit from the implementation of a CPOE system in the following ways: 1) Improved clinical decision-making in conjunction with existing HER and DSS technology. 2) Reduction in medication errors and associated costs. 3) Improved patient safety.

5 4) Decreased length of stay in hospital. 5) Workflow process improvement. 6) Compliance with federal requirements for Stage II of meaningful use. 7) Improved physician clinical staff satisfaction over time. 8) Reduction/elimination of paper orders and legibility issues.

Project Objectives
The project has the following major objectives: 1) Implementation of a pilot Clinical Provider Order Entry system at one of the systems primary care clinics that meets or exceeds MU requirements. 2) Creation of a unified implementation road map for eventual expansion of CPOE throughout all campuses of the Midwest Health Care Group. 3) Development of clinical order sets, alerts, and protocols. 4) Development of downtime procedures for planned/unplanned downtime. 5) Creation of key documentation for staff use during/following implementation. 6) Identification of resources required to maintain and expand CPOE at MHCG in the future. 7) Develop capabilities to capture data in order to produce required reports (public health reporting). The products evaluated for the pilot implementation must be evaluated by work groups that represent different types of providers within the organization including physicians at the primary care clinics, nursing home staff, facility staff and others.

Value Provided to Customers

Conformance to physician outlines standard practice Increased use of evidence-based medicine Increased patient safety Improved productivity Reduction of duplicate services Improved reporting on public health issues

Business Risks
The major risk of CPOE implementation will be resistance from providers. There is always concern that doctors will rebel against a CPOE system that they are forced to use. Another concern is that the decision support is only as good as the data that is available within the system. All aspects of the current MHCG information system should be fully integrated into the CPOE to achieve the best result possible. Risk mitigation action items include this project implementation charter, which should clearly state the objectives of the implementation. This should address the risks identified here: Risks Provider resistance Mitigation Need a physician champion onboard for all phases of project Data quality within the existing system may affect decision support system (DSS) effectiveness Aggressive implementation timeframe Old data should be screened for clarity, completeness, accuracy, and validated Work with vendor and IS to establish a realistic timeframe IS overly extended with competing projects Inadequate training of providers/staff, Coordinate timetable and resources with IS Develop a comprehensive, ongoing training

7 underestimation of training required Scope creep-costly, with delays plan, with vendor taking the lead Adhere to the established plan, unless changes are approved Large number of prerequisite tasks required Assign staff, monitor task completion closely

Vision of the Solution

Vision Statement To ensure that the Midwest Health Care Group continues to be a regional leader, excelling in the provision of safe, quality, cost effective, and timely care for our patients. We must also strive to provide a workplace for our staff and physicians that is the envy of all health care groups. Implementation of a key meaningful use (MU) core objective such as CPOE will allow the full potential of the existing electronic health record system to take effect, reducing costly errors, improving patient safety, decreasing mortality and morbidity rates, and avoiding duplication of tests. It will save our group financially by reducing administrative staff costs, improving billing practices, and increase the transaction processing rate. This project will be implemented in phases, with the first implementation occurring as a pilot at one of our primary care clinics. Major Features Implementation of a CPOE system will provide the following: 1) Key tool for order management for providers.

2) Assist in the physician decision-making process, with the use of standardized protocols, order sets, and prompts. 3) Decrease medication errors, as well as morbidity and mortality. 4) Financial savings related to decreased administrative staff costs, avoiding duplicate testing, and increasing the timeliness and accuracy of billing. 5) Support regulatory compliance with federal regulations, such as the Health Information and Portability and Accountability Act (HIPAA). 6) Will facilitate meeting MU requirements for reimbursement as CPOE is a core measure for MU Stage II compliance. 7) Supports data encryption for security measures, and transmission of data within facilities or the group as a whole. 8) Assure that the group remains competitive in the health care marketplace by adopting new technologies with a view to future growth. Assumptions and Dependencies Certain assumptions and dependencies exist for this project: 1) That the vendor selected will provide certified technology that meets MU requirements. 2) The system adopted will be scalable, patient and staff-centric, as well as being flexible and secure.

3) Resources such as staff, equipment, time, and finances will be available as needed and on schedule. 4) That key department leaders and physician champions are on board with this project. 5) A fully staffed and IS/vendor supported training program will be implemented, with at-theelbow training for physicians, along with 24/7 support. Related Projects Consideration should be given to ongoing IS projects that may reduce IS staff availability, or finances for key aspects of this project. It should be made clear from the start that MU requirements need to be met for reimbursements for physician care with the imposition of penalties for non-compliance a reality, and that all stakeholders need to fully commit to this project from start to finish.

Scope and Limitations

Scope of Initial Release The initial implementation of CPOE will be limited to one facility, using a pilot project approach to identify issues before going system-wide. It will involve nursing, radiology, physicians, pharmacy, and administration as appropriate. Workplace realignment, workflow, and physical reconfiguration of work spaces should also be a consideration.

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Interface Scope The vendor should be guaranteeing that the system selected for implementation will be capable of interfacing with the existing EHR system with future capabilities for interoperable requirements, although the same vendor is being used so this shouldnt be an issue. Organizational Scope The implementation is to be as a pilot project initially, to identify any areas of concern. Conversion Scope The conversion process should involve: 1) Converting existing data to new system format, ensuring the data is complete, accurate, and current. 2) IS staff should take the lead, with input from end-users (clinical, administrative). 3) Use of a system of validation checkpoints for accuracy and reliability after conversion. 4) Testing with live data, involving IS, vendors, end-users, and administrative staff as appropriate. Scope of Subsequent Releases Subsequent implementation of this CPOE system is subject to executive approval and successful roll-out of this pilot project. Out of Scope
Billing functions are not within the scope of this implementation. Scheduling and registration are not in the scope of the scope of the current implementation. Cleaning up backlog of maintenance request for order entry improvements and enhancements.

11 Physicians non-order documentation o o Structured notes Flowsheets

Project Success Factors Budget Highlights

Capital Budget Order Set Development and Implementation (CPOE) One-Time Capital Costs One-Time Operating Costs Proposed Ongoing Costs (Pilot Only) Contingency Total Budget for Pilot CPOE Implementation $60 million $1.2 million $200,000.00 $70,000.00 $120,000.00 $60,000.00 $1.65 million

Summary of Expense Categories Used to Quantify CPOE Implementation Costs for all campus roll-out (Timeline TBD)
Capital Budget Hardware/Server Costs Software/License Costs Network (LAN, WAN, and Telecom) Workstation Printers Interfaces Conversions Vendor Implementation Contractor/Consulting Implementation Travel Expenses Disaster Recovery One-Time Operating Costs Internal Project Teams IT Management Project Manager Analyst

12 Technical (Server/Network/Hardware) Integration (Interfaces) Database Non-IT Resources Executive Leadership Input Clinical Resources (non-IT based) Physician Resources Temporary/Replacement Staffing IT Resources Clinical Resources (non-IT) Physician Resources Training Resources Other RFP/Selection Costs Ongoing Costs Technology Costs Hardware Maintenance Software Maintenance Interface Maintenance Network Maintenance Workstation Maintenance Annual Disaster Recovery Costs Staffing Required to Maintain CPOE Following Implementation Database Help Desk Resources Project Manager Analyst Technical (Server/Network/Hardware) Integration (Interfaces) Training Non-IT Resources Clinical Resources (non-IT) Physician Resources Project Staff Resources

Timeline
Planning initiated on 03/11/13 and present project plan to the board on 03/28/13. Upon Approval, the Pilot Project will commence on 07/30/13 and be completed by 12/01/13 Approximate date of completion of major phases: 07/30/13

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Project Organization
Business Sponsors(s) Business Owner(s) Steering Committee Susan Leonard, CEO
Matthew Mabalot,, Project Manager Dwane McGowan, Clinical Nursing Officer Matthew Mabalot, Chief Information Officer Christina McClenaghan, Chief Financial Officer

Project Manager Project Team

Matthew Mabalot, Chief Information Officer IS Analysis TBD Dwane McGowan, CNO/Project Ambassador Matthew Mabalot, CIO/Project Manager Christina McClenaghan, CFO/Project Coordinator

14 Data Entry temporary staff Program Assistant TBD

Project Management Strategies

Project Meetings
Weekly and monthly meetings should be scheduled with key stakeholders and team leaders to review any issues and provide project updates. Ad hoc meetings should be set up as required, with meeting minutes available via e-mail, and in a centralized project binder.

Issue Management
This facilitates dealing with issues that need to be reviewed by the steering committee. An issue tracking log should be developed, allowing for a transparent problem resolution process, and to keep track of issues and resolutions. There should also be a clear pathway for submitting issues or concerns to the committee from any staff member.

Scope Change Management

Ideas from staff/physicians for any changes in project scope are to be fully analyzed by steering committee members to assess possible impact on timelines and resources, with large project proposal changes brought to the Management committee. Standard IS scope management forms will be utilized and placed in the Project Appendix. Scope change requests may be approved, deferred, or rejected, with any approvals resulting in an update to the project work plan.

Training Strategy
The approach to training staff and physicians should involve the vendor early in the project and continue well after the implementation phase. Feedback and suggestions from staff should be encouraged. At- the-elbow training for physicians should be a priority to facilitate acceptance of the new

15 system, and to gain end-user live feedback. Key or super-users should be selected and trained by the vendor to be used as resources on the go-live date. Training Scope Training will be limited to staff working at the proposed pilot facility for this project, and any ancillary staff that require training. Training Approach The approach to training will involve the use of demonstration stations, using real examples for staff to practice with. Super-users and physician champions will receive extended in-depth training on the new system, with the purpose of training-the trainer. Training Material Development Material required for training will be provided by the vendor, based on MHCGs requirements, and will include any specified adaptations for the group.

Documentation Development Strategy

Documentation required for this project will be customized for each facility involved. Weekly updates to plans or guidelines will be provided by newsletter and made available online. Technical operations procedure manuals will be developed and policies and procedures prepared in compliance with organizational guidelines.

Project Work Paper Organization and Coordination

An online shared database will be created for this project, with all key members given access, and a centralized folder with all pertinent documents will be made available.

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Refernces

Bayne, R., Birt, C., Hereid, D., & Hudman, L. Physician Adoption: Getting Your Physicians On Board for CPOE. (2010). Retrieved from http://www.ihsconsulting.com/images/industry_white_papers/ihs_whitepaper_3 Evans, P., Hummel, J. EHR Implementation with Minimal Practice Disruptions in Primary Care Settings: The Experience of the Washington & Idaho Regional Extension Center. (2012). Retrieved from http://www.healthit.gov/sites/default/files/ehr-implementation-wirec.pdf HealthIT.gov. How to Implement EHRs. (2013). Retrieved from http://www.healthit.gov/providersprofessionals/ehr-implementation-steps/step-1-assess-your-practice-readiness The Leapfrog Group. Computerized Physician Order Entry: Costs, Benefits and Challenges. (2003). Retrieved from http://www.leapfroggroup.org/media/file/Leapfrog-AHA_FAH_CPOE_Report.pdf The Leapfrog Group. Factsheet: Computerized Physician Order Entry. (2012). Retrieved from http://www.leapfroggroup.org/media/file/FactSheet_CPOE.pdf Wagner, K.A., Wickham Lee, F., Glasser, J.P. (2009). Healthcare Information Systems: A Practical Approach for Health Care Management (2nd ed.). San Francisco, CA: Jossey-Bass