Anticlue

Bad estimates lead to bad cost projections which ultimately equate to poor delivery. The problem being when estimates are needed for efforts to be completed to project costs. Often a project is estimated for resource effort before it is budgeted. Therein lies the problem. The estimator is rarely the individual doing the work and the amount of work may not be fully understood. Another issue is the skill of the individual doing the estimate, the work it takes one individual to do in 12 hours may take another individual 4 depending on the experience and talent. However your individual with 4 hours is probably backloaded with work.

The best estimates often come from the individual accountable for doing the task at hand, there is a sense of ownership among the team and individual of the estimate. There is also a shared understanding for how the project work was estimated. So how can we get better estimates in Healthcare IT?

3 Tips to improve estimating practices

1. Ask the vendor - Often if you are purchasing or implementing a system, during contracting ask the vendor for the amount of effort. Good vendors will share their resource estimates and effort. I know McKesson and Cerner have these to help the organization understand how much effort they need to pony up. Poor vendors will tell you that they do all the work. Truthfully, in my almost 2 decades of experience, I have never been engaged in implementing a system where the vendor did all the work.
2. Have the resources accountable for implementation assist with the RFP evaluation- The best way to bring your team is to have them partake in the RFI, RFP efforts. During the evaluation of the RFPs, have them estimate implementation efforts. Not only does this help have a solution resolved upon a needs assessment, but the requirements are now known.
3. Always have staff do the estimate - While it may be hard, let staffing have the final estimates to verify and assure they are comfortable. Once on a project all of the estimation was completed by a senior technology director. This individual was new to the organization and not familiar with how interwoven the old technology (Novell File Servers) where to the organization. The estimate provided to retire was way too short of a timeframe and didn't consider some integration points with the mainframe. Having the staff review the estimate and rework it, provided an opportunity to properly frame the project effort

The Take Away

It is best to deploy all three of these practices to improve the art of estimating. Having better estimates will help with the overall portfolio health, and decrease the amount of technical debt incurred.

All in all it was a good conference over at HIMSS 2010. I got to see old colleagues and catch up, volunteer and coordinate at a couple of events, attend some good educational sessions, and spent a day of the vendor floor. Everyone made it home safe whether driving or flying.

Among other activities, I had the chance to engage in good discussion on ambulatory emr installation between those of us in Florida. The discussion ranged in barriers to adoption for the stimulus package. The tripping points seem to be the same, so look forward to an upcoming blog post.

As always the vendor floor at HIMSS is an educational experience in itself, over the next couple of weeks I'll be adding to my vendor spotlight posts, probably encompassing 6 overall - give or take a few. For the vendor hall, I have to say that those in the C building didn't get the "plush" seats. The traffic wasn't the same as the B building. Additionally, the vendors focused upon the suits, so I was able pursue quite undisturbed.

Highlights from the Vendor Floor

• The transcription vendors seemed to have increased in booth size, Crescendo, Nuance
• Epic had the most be visitors, followed a close second by Allscripts
• HL7 Session on Semantic Interoperability was well delivered and the analogies where ideal for such a confusing topic
• 3M with the Nascar was marketing genious for the South
• Beacon Partners layout was the best of the consulting firms, and they had insightful things to say
• iPods and iPads where the giveaways of choice this year
• I picked up the 2D barcodes on the patient arm band from Zebra. These left more space for larger font print on patient wrist bans., and a lot more barcodes, as it is the size of a dime.
• McKesson's booth was not the blaring look at me of past years, although the color scheme remained the same. I think my eyes are now just used to the alert and avoiding the visual noise.
• GE's booth was massive with an upstairs and downstairs. Appeared to have an integrated view of the product and clinical engineering offerings
• Siemens had two different booths, one from their Products (Soarian, Invision), the other for clinical engineering and pacs
• Rubbermaid had a good carts on wheels offerings, but the wheels on the devices didn't look robust enough for speed bumps of carpeted floors.
• Motion Computing wasn't as packed as in past years.
• Dell's both had a Perot Consulting component, in addition to a Microsoft Surface and devices
• The HIE was definitely work the 20 minutes
• I'm wondering if Microsoft will have the biggest floor space next year just looking at the square footage of the sentillon and Microsoft booths.
• CSC really kicked it up a notch for the Healthcare Vertical Offering.

Microsoft continues to try to break on into the HCIT and there was quite a bit of muss and fuss about the Microsoft Booth. It was hard to get around to see everything, but I was able to check out HealthVault Community Connect, Amalga Unified Intelligence System, and Microsoft Surface.

HealthVault Community Connect is a new product which enables patients and their referring physicians to access their visit's patient data. Before the patient arrives for their scheduled visit, they have to create a HealthValut personal e-health record account. When they are discharged, the information is moved to the HealthVault Account. While let it be said it is great to get the information distributed into the patient's and referring physicians hands, I'm concerned about capturing with each patient a nuance of which PHR they use, and distributing it. Afterall XML to XML is another whole set of integration standards and exchange, given that most physician practices are beginning to invest in an EHR. It has a way to come, but there is a glimmer of that interoperable future.

Amalga Unified Intelligence System provides a dashboard view of your determined key performance indicators. Once again, getting the data will be crucial, however the look and feel of the application lead me to envision it on executive's desktops right next to MS Exchange. I wonder if Microsoft will develop an "Active Synch" like component, so the executives can get the dashboard on their iphone or blackberry.

Finally, the technology of Microsoft Surface has portrayed as a conference table for communications. There was a custom developed application running by I think Linksys. Anyway, this technology would be helpful from a facility design perspective for space and telling who is who. However the downfall is that the apps must be made to work upon the technology, so its adoption will need to be with the vendors. After all investing in a McKesson system and then throwing the $90 million out the window for counterspace will not be working.

All in all I liked the Microsoft booth, but I'm going with a 3 out of 5 stars.

Ever since Avaya picked up Nortel and the dawning of Aura Session Manager, I have been hopeful of expecting good things in healthcare telecom. After all. only a data center upgrade has the same amount of capital request to update existing PBX's, Voice Mail, ACD's, and VOIP. For those of us who have been "concerned" about having end of life Nortel Infrastructure, and looking at those handsets and desk phones brings shivers of operational supply expense increases. We can breathe again. The upgrade path converges slowly instead of instantly.

Avaya had a nice eye catching display this year at HIMSS. Among the products showcased the star was the mobile device checkout system. At change of shift, swipe in via the bar codes on the employee badge and phone. The phone is then registered with a unique phone number. Additionally with the RFID device in the phone, one can now track staff along with equipment, although I'm thinking if you have a staff tracking problem it is cheaper to appropriately address behavior problems rather than invest in an RFID infrastructure.

Another good twist was the "patient admit coordinator" system. It over communicates 3 ways, voice, email, or im for patient admissions. I like the over communication, but it needs to flow with the workflow of discharge, bed-cleaning, then admission. Most organizations are good at communicating admissions, the problem or constraint is available beds. It would be cool to see if we could make it a patient discharge then patient admits.

All in all, I'd say the Avaya display and product was 3 stars out of 5 stars. After all, I got around without being swiped.

Ever consider that the constant, "Hey, I need another server" cry of the applications folks maybe causing heartburn in the CTO. The Data Center Expansion Educational Session went over a common problem in hospital facilities, a 1970's datacenter for a 2010 infrastructure. Between growing power needs, constrained air conditioning, and decades of cabling "oh my". It was a good session, the takeaway is going to be a tour of a couple of data center's to discern a strategy. Afterall, as we become more electronic as industry, the datacenter will be a crucial component.

I'm please to share that the HIMSS PM Sig and PMI Healthcare SIG combined meeting went off very smoothly. A good turnout of 70 individuals attended our SIG meeting that is 10 percent of our membership. The HIMSS PM SIG is the largest within HIMSS and we are always looking for more members. PMI Healthcare SIG had a simultaneous webcast for the event, which was attended by 9 individuals. The presenters brought a good overview to the need of project management offices and project managers. It was agreed by both groups to have a combined event next year for our membership. A very good point was brought up from the membership for both groups to work together on template development for healthcare.

A couple of interesting items on the ribbons everyone is wearing upon their badge, the PMP ribbon is out of stock. My favorite ribbon is the Old Buffalos Rule. As one was mentioning to me, whipper snappers going running along hitting walls as we sprint, the old buffalos stroll knowing from experience where the walls are ahead of time. As a whipper snapper, I liked that concept.

After the PM-SIG, we checked out the Solution Q product. I requested a copy of the Market Survey they mentioned at the SIG meeting. It said that of their survey population 50% had a PMO. Let me know if that sounds a little high for you? I'm thinking of getting HIMSS and MUSEWEB to do a combined survey of their membership.

Buzz about HIMSS

• Blumenthal and the early morning CIO session, Did the points resonate?
• HIMSS should provide benchmarks on the support needed via FTE (full time equivalents) as clinical system adoption occurs.
• HIMSS educational sessions seem to be CIO focused, a broader education lessons and experience learned would be welcomed.
• The SIGs maybe receiving more support from HIMSS.
• Snow in Atlanta, last year in Chicago - Guess you can't control the weather.
• There is brilliance in that shoe shine idea
• A vendor's name who rhymes with heinken is giving away free ones if you can rhyme it.

Please feel free to share your experience from the HIMSS conference. I hope everyone has a safe journey home today. I'll be out and about on the vendor floor. Without the suite, I'm pretty sure I'll be free of the booth babes and salesman.