Resource: Ch. 6 of Essentials of Health Information Systems and Technology.Consider the following scenario:During the third week of your internship, the CIO emails your team several examples of other IT project implementations. Later that day, she says, “Review the examples I sent you about the implementation process. I attached a list of questions for you to answer about how the implementation process works and why IT projects sometimes fail. I’m most interested in your analysis of how organizations like ours can minimize the occurrences and effects of IT failures.”Read the Case Study–Memorial Health System CPOE Implementation. located in attachmentWrite 100- to 125 words in which you answer the following question:What is the typical IT implementation process? What are the roles and responsibilities involved in system implementation?cite/add references
hcs483_r8_wk4_casestudy_memorial_healthsystems_cpoe_implementation.doc
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Case Study—Memorial Health System CPOE Implementation
HCS/483 Version 8
University of Phoenix Material
Case Study—Memorial Health System CPOE Implementation
Memorial Health System is an eight-hospital integrated health care system in the Midwestern
United States. The health system has two downtown flagship tertiary care hospitals, each
licensed for more than 700 beds, located in the two major metropolitan areas served by the
system. The remaining six hospitals are community-based facilities, ranging in size from 200 to
400 beds. These hospitals are located in the suburban and rural areas served by Memorial
Health System.
Four years ago, the system’s board of directors approved a multi-million-dollar initiative to install
an enterprise-wide clinician provider order entry (CPOE) system intended to dramatically reduce
medical errors. Today, the system is far from fully implemented, and, in fact, has been removed
from all but one of the two tertiary care facilities, where it remains in pilot adopter status.
At the time the board approved the CPOE initiative, the project was championed by Fred Dryer,
the CEO, and was closely supported by Joe Roberts, the chief information officer (CIO) of the
health system. Even during its proposal and evaluation by the board, the project was considered
controversial by some of the health system’s stakeholders. For example, many of its physicians,
who are community-based independent providers, were adamantly opposed to the CPOE
system. They worried that their workload would increase because CPOE systems replace verbal
orders with computer-entered orders by doctors. Dr. Mark Allen, a primary care physician
commented, “The hospital is trying to turn me into a 12-dollar-an-hour secretary, and they aren’t
even paying me 12 dollars an hour.”
In securing board approval, Dryer and Roberts presented an aggressive implementation plan that
called for the requirements analysis, Request for Proposal (RFP), vendor selection, and project
implementation to be completed in less than 18 months in all eight hospitals. During the
discussion with the board, several of the members questioned the timeline. One noted, “It took
you two years to set up e-mail, and everyone wanted e-mail. This will affect every clinician in
every hospital. Do you really think you can do this in 18 months?”
In an effort to demonstrate results, Dryer and Roberts demanded results from the clinical and IT
team formed for the project. By this time, a rushed requirements analysis had been completed, an
RFP issued, a vendor selected, and a contract signed. The acquisition process took a little more
than 6 months, leaving a year for the implementation.
In protest, a number of prominent physicians took their referral business to the other health
system in the area that seized on the controversy by promising that they would not use a CPOE.
Shortly thereafter, the two leading champions for CPOE—Dryer and Roberts—left Memorial. The
chief medical officer, Barbara Lu, who was a vocal opponent of the project, was appointed interim
CEO.
Although Lu was an opponent of the project, many members of the board still supported it. In
addition, none of the board members wanted to lose a substantial down payment to the vendor,
so Lu was instructed to proceed with implementing the system. Lu appointed a close colleague,
Dr. Melvin Sparks, to serve as the interim CIO of the system. Sparks was both a practicing
radiologist and a degreed computer engineer, so Lu thought he would be an ideal CIO for the
system. Sparks hired Sally Martin as the executive project manager overseeing the
implementation.
After evaluating the progress made to date and preparing a detailed thousand-step project plan,
Martin reported back to Sparks on the status of the project with an exceptionally detailed report.
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Case Study—Memorial Health System CPOE Implementation
HCS/483 Version 8
Several key points were noteworthy in her report. Because of the rushed requirements analysis,
several key workflow and system integration issues were missed. Consequently, to complete the
project in the remaining 12 months, the organization would have to do the following:
•
•
Double the IT staff assigned to the project from 16 to 32 people.
Purchase approximately $500,000 in integration software not already budgeted.
o Alternatively, the scope of the project could be reduced from an enterprise
deployment to something less than that.
o Alternatively, the duration of the project could be doubled to 24 months, keeping the
staff flat, but not avoiding the $500,000 software cost.
Dr. Sparks did not respond well to the news, exhibiting a great deal of anger at Martin, who was
not working for the health system when the project was scoped and budgeted. Sparks yelled at
Martin and told her never to come back into his office with bad news again. Her job, Sparks
screamed, was to “figure out how to turn bad news into good news or no news.” As she left
Sparks’ office, Martin resolved never to convey bad news to Sparks again, no matter how serious
the issue was.
Over the next 12 months, the project progressed but got a bit further behind schedule each week.
Martin reminded herself that she wasn’t conveying bad news to Sparks. In each status review
meeting, Martin always presented a project schedule that was on scope, on schedule, and on
budget.
During this time, the health system took on a number of other important IT initiatives requiring
human resources. Each time another project fell behind schedule, Sparks took resources from
the CPOE project. From the 16 people originally budgeted, the team was reduced to eight. The
only positive aspect was that the project, which was costing money even though it was making
little or no progress, was expending less cash as it made no progress.
As the project went into its 16th month, two months before the scheduled launch, nearly all the
project budget had been consumed, and—in an effort to save money—the end-user training
budget was cut to the bare minimum. At the same time, some doctors who had not left the system
attended the CPOE vendor’s annual user group meeting. They saw the release of the vendor’s
most recent system and immediately decided they wanted it for Memorial. Upon returning to the
hospital, the doctors met with Sparks and persuaded him that the only hope for enlisting
physician support for the changed workflow was to adopt the newest version of the software,
which was just being introduced. The physicians told Sparks they had persuaded the vendor to
appoint Memorial as an alpha site for the new software.
When Sparks informed Martin of the change in the scope of the project, Martin was concerned,
but remembering Sparks’ reaction to bad news, she kept her thoughts to herself. She framed her
questions in the form of the risks that such a major change in direction might cause with so little
time to recover. Sparks smiled and told Martin, “Don’t worry; it will all work out.” So, two months
before the launch, Martin worked with her team to alter the project work plan to install the new
software, test the software, configure the software and interfaces, and train the users—all in two
months, even though the same activities had taken almost eight months the first time.
The scheduled date for the launch arrived, and all eight hospitals went live on the new CPOE
system on the same day. The new software had flaws. The lack of end-user training was
apparent, and the many requirements missed during the analysis became immediately obvious.
Doctors could not log on to the system, and nurses could no longer enter orders. Patients were
kept waiting for medications and tests.
After several days of this, Lu instructed Sparks to decommission the CPOE system and revert
back to the manual procedures. An unknown physician was quoted in a major health care
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Case Study—Memorial Health System CPOE Implementation
HCS/483 Version 8
publication—under the title “CPOE Doesn’t Work”—describing the debacle at Memorial Health.
During the project postmortem, Sparks expressed surprise the project was not going as planned
and asked Martin why she had not been more forthcoming about the problems, issues, and risks.
The vendor took six months to fix the flaws in the software, and—30 months into the project—
CPOE was launched again. However, this time it was in one ICU in one of the tertiary care
hospitals. Four years after the beginning of the project, this is the only unit in the entire health
system in which CPOE is operational.
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