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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 3 - OverviewGeneral Guidelines for Executive Management

What is the Systems Development Life Cycle (SDLC)

Activities for the Planning and Analysis Phase in the SDLC

This is Module 7: Using the Systems Development Life Cycle. We will explain how to use the Systems Development Life Cycle to guide the initial activities of the IT Governance committee. This is a conceptual model that will allow the organization to anticipate the natural course of a software implementation or upgrade project. The goal of this module is to build on the understanding acquired in Modules 1-5 on Project Management, and Module 6 on IT Governance. Once this foundation of understanding is in place, it is easier to move forward with confidence. 2What is the Systems Development Life Cycle (SDLC)?

The Systems Development Life Cycle (SDLC) is a conceptual model used in project management that outlines the stages involved in an IT project, from start up to implementation and maintenance of the completed project. It is used as a high-level guide to IT Governance activities and the development of the project plan.

Retrieved April 2013 from http://searchsoftwarequality.techtarget.com/definition/systems-development-life-cycle Configuration for most BH EHR projects

The Systems Development Life Cycle or SDLC outlines the natural flow of activity in a software implementation or upgrade project. This particular approach is called the waterfall model. It walks through each phase of the project, beginning with planning, moving on to analysis to identify needs, then purchase and configuration of an EHR, full implementation of the system, and finally system maintenance.

The phases follow a logical progression, preceding steps leading naturally to the initiation of the next. In this module we will be drilling down into the Planning and Analysis stages. Every step of the cycle has activities and also costs associated with it, including some that providers might not be expecting. For example, start up for an EHR may be relatively inexpensive, but maintenance of the system over the long term may be costly and add to the project risk.

Retrieved April 2013 from http://searchsoftwarequality.techtarget.com/definition/systems-development-life-cycle

3Structuring IT Governance TasksApplying SDLC at Start UpSystems analysis and requirements definitionSystem physical construction (hardware, software, broadband access, communications, security issues)Implementation of the project activities and the associated tasks, from vendor selection to Go Live Use of the system, including managing the transition from the old way of doing things to the new way of doing things, and ongoing training needsPost Go-Live system evaluation (usually after a year of running the system) and system maintenance, including reconfiguring the system to accommodate changing regulations, improving reporting capacities, managing vendor updates, etc.

Item 1 in this list reflects the planning and analysis stage of the SDLC. In this presentation we will be discussing this stage in terms of activities and project initiation start-up tasks. Lets examine what we mean by systems analysis and requirements definition. 4Systems Analysis Key Concepts

Systems analysis is an expansive topic area that studies sets of interacting entities. At its most basic level, systems analysis is a fact-finding mission and in this case those facts are used to define what the organizations business requirements actually are.

The systems analysis can produce many different products, but to support start up it should provide a thorough inventory of the information assets and liabilities that currently exist, staff skills for working with the EHR, and the System Requirements Definitions document which includes a Requirements Traceability Matrix.

The System Requirements Definitions is simply a list of all of the things that the EHR system has to be able to do in order for the organization to conduct business in the electronic environment. Ideally, the adoption of an EHR system will do more than meet business requirements. It will also support more efficient and effective business processes. But the starting point is understanding what the organization actually needs the system to do.

The Requirements Traceability Matrix is used as a central reference that identifies the reason or driver for groups of requirements. This matrix can then serve as a road map for the customer as they negotiate the maze of EHR offerings, systematically testing and validating the extent of functionality in different products. The information derived from the Systems Analysis helps to ensure that verified system requirements are driving the IT Governance decision-making processes, and not individual preferences or interests.

Lets look first at the IT inventory and staff skills matrix.

5Systems Analysis Discovery Inventory physical resources (hardware, software, infrastructure, licenses, etc.) Includes version numbers, licensing costs and 3-5 year IT strategy and budget for maintenance and upgrade http://techsoupforlibraries.org/cookbook-3/maintaining-and-sustaining-technology/tools/hardware-and-software-inventory-worksheets

Inventory staff resourcesDevelop a skills matrix and ask staff to identify their computer skills including any certifications in IT, previous experience with using an EHRhttp://toolkitcafe.com/assess-it-support-capability-and-capacity-with-an-it-employee-skills-matrix/

The foundation for the systems analysis is the discovery process. This process begins with systematically documenting the resources that are in-house and what they cost to use. It usually begins with an inventory of hardware and software, since these are the most tangible assets and liabilities. This should contain the most current information about IT system assets. The inventory includes details about each piece of equipment, including estimated value, ID numbers, operating systems, hard drive capacities, memory, speed of broadband access, and so on.

Less tangible assets and liabilities to be considered include human resources. The discovery process should document existing staff skill sets and all certifications, especially those related to information technology. Staff may need additional training and certifications, and new staff may need to be hired, depending on the EHR selected. Facilities and maintenance is also a consideration in the discovery process. Network servers require dedicated space in a carefully controlled and very secure environment. New wiring can be expensive (and difficult) to run, especially through an older building.

Parallel to this activity, the organization can conduct the second aspect of discovery, the identification of high-level business requirements these are the tasks that the EHR actually has to be able to complete in order to conduct business. You can build your own Excel workbook with spreadsheets for these activities, or you can use free, online resources and templates. Links to such resources are provided.

6Getting ReadyUpdate policies and procedures; forms and reports

Create a data dictionary

Gather examples and guidance for developing the list of system requirements (see next two screens)

SAMHSA guidancehttp://www.samhsa.gov/samhsa_news/volumexiv_6/index.htm

While these inventories are underway, there are other chores that can be completed to help prepare your organization. Clinical practice requirements and standards have to be clearly defined and identified in the Policies and Procedures manual. These practices are usually aligned with accreditation requirements, state regulatory requirements for licensing, and so on. The Policies and Procedures manual should be up to date so that the organization can easily identify these requirements and trace them to the end user responsible for implementing them and also to the regulation and/or requirement that it is intended to meet. Forms should be updated and clarified to avoid uncertainty about the nature of the data to be collected, it can be very helpful to build a data dictionary that explains exactly what information goes into each field in every form in use. 7Guidance For Behavioral HealthPlanning Your EHR System: Guidelines for Executive Managementhttp://www.satva.org/white-papers/MHCA-SATVA-PlanningYourEHRSystem.pdf

The RFP Process for EHR Systemshttp://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961

EHR Toolkit- Behavioral Health Providershttp://www.hinfonet.org/for-providers/ehr-toolkit-mental-health

Mental Health Corporations of American (MHCA) and the Software and Technology Vendors Association (SATVA) provided guidance to behavioral health provider executive management that leverages years of experience on working in this field. Should your organization decide to go this route, the American Health Information Management Association explains the RFP process for obtaining an EHR system. In consultation with the National Learning Consortium, HealthInfoNet assembled a toolkit targeted to Behavioral Health Providers for EHR Implementation. All of these materials can help in understanding what to expect in this type of project.

http://www.satva.org/white-papers/MHCA-SATVA-PlanningYourEHRSystem.pdf http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961 http://www.hinfonet.org/for-providers/ehr-toolkit-mental-health

8SummaryThe project tasks can be aligned with the progression of activities in the Systems Development Life Cycle (SDLC) waterfall model. This model allows an organization to anticipate each of the stages of adopting electronic health record technology

The initial task is Systems Analysis and Requirements Definition. This begins with a discovery process. This can be viewed as an inventory of the organizations information technology assets and liabilities. While the inventory is being conducted, the organization can also conduct a business requirements analysis. The ultimate product of the analysis is the

We explored the basics of the Systems Development Life Cycle, which is a concept that can be used to organize IT Governance activities and the development of a project plan for both EHR implementation and meeting the Standards for Meaningful Use. It allows the organization to proceed in a series of phased steps that are common to every IT project. We focused in on the first step in the SDLC concerning the analysis of the existing system and the requirements definition for the new system. It is very helpful to begin preparing the organization by updating Policies and Procedures and also by updating forms and reports. A data dictionary can be very useful in ensuring consensus on what information needs to be collected.

9We 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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