Anticlue

Educated Sanctioning

We have all been there, asked to do a project that we think why in the world do they want to do that instead of this. Or we have had the other extreme anxiously waiting at the bit to do the latest and greatest, but being told this isn’t where we are extending our resources at this point in time.

The truth of the matter is that if you work for a corporation, someone has to agree and bless the work you are doing. In other words sanction that it is ok to go down that road. If you are working on a project that isn’t sanctioned by the powers that be, that project has one of the main factors of failure.

Taking a step back there is some key information that is needed so that the project does get blessed. First, there has to be a realistic business problem defined and quantified, and the picture of the future state needs to be explained. For example, wanting to place an rss feed on the what’s new is cool, but what problem does it solve? However, allowing a way for employees to receive instant updates about media news, may be a good use of resources, but having an rss feed of new PACS images with the archaic PACS system is probably not fruitful. Another factor is realistically guestimating the work effort needed. Back to our example, the rss feed may be simple, but pushing a news reader to 1300 desktop may be a bit more work. Along with guestimating work, estimating impact on networking, hardware, systems, and process is needed. The information on all of the above, gives an idea of what the project will do. With this information, the sanctioner can make a good decision, and the project will be well on its way.

Tartan List Serv

As was pointed out the other day, Tartan currently has a list serv at atopica.

Grading Healthcare IT organizations

In this month’s hfm, there is a good article for viewing how your IT department stacks up. In my opinion, the article does a great job of evaluating an IT’s department performance based upon organizational investment, organizational perception, fact based offerings, organizational planning, staffing, and organizational policies.

The article breaks the report card into six possible grades.

The first criterion examined is cost. Cost of the IT department is defined as percentage of the operating budget dedicated to IT. A side note is that operating expenses exclude capital expenditures. This means that the new PACS system acquisition cost is not included as a part of the operating budget of IT. And since capital expenditures are excluded, it also makes sense to exclude depreciation of capital expenditures as the study does.

So the grading as a percentage of total operating costs is as follows:

The next criterion reviewed is staffing. Staffing is examined based on the number of FTEs in IT per 100 adjusted occupied beds, AOB. The adjusted calculation includes the acute care, outpatient, and non-acute modalities. The type of system processing is also reviewed. There are four categories of system processing allowed, remote, in-house servers, in-house mainframes, or all of the above.

In order to grade your IT organization on staffing per 100 AOB follow the chart below:

The next grade is passed upon User Satisfaction. The survey is a mechanism to rate IT by the customers of the organization. A good approach by the article is to ensure that the clinical and financial customers are included.

The user satisfaction grading is as follows:

The next criterion was very interesting. The IT organization is grated upon Physician-friendly features and capabilities offered by the clinical systems. The features included are:

• Patient “rounding” census reports
• Graphs of patient test results
• Highlighting of abnormals
• Computerized Physician Order Entry
• Personalized Order Sets
• Knowledge searches, as an online physicians desk reference.
• Medical Alerts and reminders
• Intranet for physician policies and memos
• Face sheet retrieval for physician billing
• Support from a dedicated physician informaticist in IT.

So count the number of features offered to a physician, and grade based on count.

IT governance is also a category for grading. The grade is based upon how many of the following governance structures an IT organization has:

• To whom does IT report? Is there a position overseeing IT means a positive answer and a count of this criteria. If individual departments have siloed IT support, then this evaluation is not included in the count.
• Is an IT steering committee in place?
• Does that steering committee meet on a scheduled basis?

If you have a CIO in place with a steering committee that never meets, the IT governance count is 2.

So the governance policy grading is based on the answers:

Finally the IT strategic plan is graded based on the following criteria:

• The plan is current and has provisions for updating.
• The plan is well thought through, includes capital and operating budget, new developments within the industry, the staffing requirements and implications of staffing changes, a computer “refresh policy”, and the tactical initiatives for one to two years.
• The plan should be including executive and customer input. In other words, not written in a vacuum in IT.
• Most importantly the plan should be directly corresponding to the organization’s business plan with support of the organizations goals.

So grade the strategic plan based on the number of criteria being met

With the investment in healthcare IT, I think this grading mechanism gives an organization a good sense of their starting point, and maybe even a future state of where they want to go.

Council on Technology and Innovation

The Centers for Medicaid and Medicare Services has launched the Council on Technology and Innovation (CTI). Its purpose is to improved methods for developing practical information about the clinical benefits of new medical technologies resulting in faster and more efficient coverage, coding, and payment of these medical technologies.

Managing the Critical Path

A couple of tips to managing the critical path of a project:

• Determine and group the risk to the critical path such as cash flow rate, skills inventory, flawed deliverables, configuration management and change management.


• Establish a proactive process to manage the constraints on the critical path, this helps to ensure resources, materials, and facilities are available when needed on the project. Identify which critical path the constraint affects, there may be many, and remember to prioritize the constraints


• Ensure that the skills needed for the critical path are available, if not set up a knowledge sharing process.


• Any critical path risk should be in the risk management plan and risk log with the appropriate allevaition pattern


• Establish a communication channel and schedule to handle the management of the critical path


• Manage the critical path timeline, so that any slack time can be utilized. In other works, move it up the chain if at all possible so everything isn't waiting for the last minute.

CPI and CV Components

Cost Performance Index (CPI) is the ratio of costs budgeted to perform the work to actual costs to perform the work or BCWP vs ACWP. The formula is CPI=BCWP/ACWP. A CPI greater than one indicates a favorable result or cost under-run. A value of less than one reporesents a cost overrun. The use of CPI and CV calculations help IT project managers to ascertain if the spending trend is positive, negative, or neutral in relation to the work performed.

Cost Variance (CV)is the difference between the costs budgeted for an activity and the actual cost to finish that activity. The formula is CV = BCWP-ACWP. A positive reult indicates that the project in under budget, and a negative result means that the budget is overrun.

SPI and SV Components

Schedule Performance Index (SPI) is the ratio of work accomplished versus the work planned. The formula is SPI = BCWP/BCWS.

Schedule Variance, is the measured difference between the planned or scheduled activity duration and the actual activity duration. It is the difference between the Budgeted Cost of Work Performed (BCWP) and the Budgeted Cost of Work Scheduled(BCWS). The formula is SV = BCWP-BCWS. A positive SV indicates that a task is ahead of schedule and a negative SV shows that a task is behind schedule.

In MS project, Select the Gantt Tracking, then View -> Table -> Variance.

Earned Value Components

Earned Value Management (EVN) is a management technique that relates resource planning to schedules and costs in time-phased increments. It allows for accurate assessments of status to date and is utilized to calculate estimates to completion of project.

Earned value refers to a cost-based performance measurement that compares the amount of work that was planned with what was actually performed to determine if cost and schedule are proceeding as planned. Earned value analysis provides a more accurate view than looking at cost or schedule variance separately. This information alerts the corrective action that must be taken to complete the project successfully.

The elements of earned value:

• Budgeted Cost of Work Scheduled (BCWS) The estimate of costs needed to complete the scheduled project work.


• Budgeted Cost of Work Performed (BCWP) The estimated of costs for work actually completed. Also know as Earned Value.


• Actual Cost of Work Performed (ACWP) The cost of completing the project work

To calculate earned value:

1. Calculate the Budgeted Cost of Work Scheduled (BCWS) for a given period. These amounts were determined when you develop the project budget and should be available from the baseline in MS Project.


2. Estimate the percent complete of the work scheduled for the given time period.


3. Calculate the Budged Cost of Work Performed (BCWP), or earned value, for the same time period by taking the percent complete of work times the BCWS.


4. Calculate Actual Cost of Work Performed (ACWP) for the same period by determining the actual amount of money that has been spent on the work for this time period

In project to see this by a cost per task. Select the Gantt Tracking, then View -> Table -> cost

HIMSS Analytics researching IT Governance and Leadership

This looks to be a good sign!

Scottsdale Institute (SI), Lawson Software and HIMSS Analytics have joined forces to conduct the industry's first definitive study on IT Leadership and Governance Practices, which is underwritten by Lawson. HIMSS Analytics will prepare the report of findings for review and discussion at the SI Spring Conference. The goal of the survey is to help you compare practices with others and identify ideas that may help increase the value of IT-enabled clinical and business initiatives. HIMSS Analytics will
collect information from members of senior leadership teams regarding issues such as:

-What models of IT governance and reporting are being utilized? What are some of the successful practices?
-Who is responsible for driving value from IT?
-What is the role of the CEO in IT decision making?
-What involvement does the board have in IT?
-What are the top two factors for IT success?
-Where is the industry on the "clinical transformation" curve?

I'm very interested in the result of this survey. Hopefully it will have enlightening outcomes.

How to develop a communication plan

Here is a quickie guide to for a communication plan

1. Define the communication audience.


2. Determine the content and frequency requirements for the audience, consider separate documents for the sponsor, stakeholder, supplier/vendors, and others.


3. Identify special communication requirements of non-collated and international teams.


4. Plan performance reporting and set expectation regarding the communication process


5. Identify communication channels possibly your organization has a predefined policy


6. Assigned who and how is going to communicate


7. Schedule the time for communication (ensures it gets done)

Project Performance Reporting

Project performance reporting refers to disemminating project performance information. Reports need to provide info at a level of detail appropriate for the audience. Sometimes these reports include a Gantt chart, S-Curves, and histograms.

The type of performance reporting are:

• Status Reporting - an analysis of the current state of the project, any variances within either schedule, budget, scope, resources, quality or risk, also include the next steps of the project.


• Progress Reporting - a report of what has been completed


• Forecasting - How the project is expected or forecasted to perform in the future.

Darth Tater!

This is just neat and cute. Check out Darth Tater!

Schedule-Driven versus Resource-Driven Projects

A project is schedule-driven when the final delivery date is the overriding constraint that the sponsor or customer has expressed. Schedule-driven projects will consume whatever resources are required to ensure delivery on the established.

A project is resource-driven when the availability of resources, particularly skilled resources and costs, is the overriding constraint that the sponsor or customer has expressed. Resource-driven projects must expand time or sacrifice quality to remain within the constraints of the resources.

The constraint of schedule-driven or resource driven governs the decision of the project.

Social Circles

This is a cool concept. The social circles surrounding a couple of list servs are visually displayed. Take a look here.

A great way to immediately get the sense of the room.

Visit Types

When constructing a hospital information system or working within a hospital it department. Its a good idea to know the types of patient visits that hospital supports.

For some patients, a bed must be immediately assigned at the time of registration. (Ambulatory Surgery, Inpatients)

There are other patient visits, for which a bed is optional. For example private referred visits.

There are some patient visits, which are always daily only. So instead of employing someone to expire that visit, the system can do it automatically.

The behavior of an inpatient visit can be simultated. For example the patient can be transfered, and discharged.

There are also visits that are recurring, where a patient can have multiple active visits. For instance, an individual who is having radiation therapy.

Strategic Planning for IT

Let’s face it, we need to plan. If we don’t plan on an organizational level about how IT is utilized, we end up with an enterprise architecture that resembles playing lego as a child. Remember playing with legos, the first thing we did was to spread the contents of the lego box out on the floor, so we could see what we have. We have started building something all over the place. There were some lego pieces that are just out of our sight – hidden away by a sibling because it is a valued piece. Finally, there may even be some pieces in the box, because they didn’t make the first dump. Without any planning your enterprise architecture will begin to resemble this layout.

So what needs to be in place to plan?

First, there really needs to be C-level commitment to the concept. (Many C’s not just one lone wolf)

An organization needs to have a current strategic plan. The organization needs to have organizational leadership. The organizational culture has to be accepting of change and its management.

There needs to be in place a clear, concise decision making process that leaves a history of why this decision was reached and followed, based on information at the time.

When an organization starts planning, the first time there will be a lot of proposals. So before hand, have well established criteria for sorting through them.

There also needs to be strong communication, with both parties listening and contributing. Communication isn’t the bearded guy in the room talking and everyone else looking off into space. A way to share knowledge on the main concepts, advantages, and disadvantages of the proposals is a main part of the communication.

Establish an office with dedicated individuals (even if it is a 50% of their day job) to reseach, discuss, and review the proposals and issues. This office should be comprised of a technology it person, and an applications IT person. There should be members of the business community too. The new conceptual proposals that will radically have an effect on the bottom line or workflow and are costly, can be piloted by this office and the findings summarized and documented. For example if there is a proposal for the providers to start using a PDA system in Neurology. A pilot can tell you the hardware, software and support costs of a PDA deployment, and the needed integration with other systems the mail system, the clinical data repository, and maybe even the physician order entry system.

XForms Validator

Another addition to the OpenSource community is the online XForms Validator. The project on SourceForge is found here.

Tartan

Tartan a new command-driven service framework for CF was released by Paul Kenney.

To look more into the info check out the following:
Tartan: a new service framework for ColdFusion
http://sourceforge.net/project/shownotes.php?release_id=297551

Assessing Project Feasibility

Feasibility analysis determines the likelihood of project success. It requires that all elements impacted by the proposed solution be studied.

To perform a feasibility analysis, a couple of guidelines to follow are:

• Make sure that you have addressed any regulatory constraints by researching industry or government regulations that apply. Examples are Federal Regs, OSHA, FCC, Dept or Transportation, and Dept of Labor


• Pay special attention to cultural achievability of the proposed change. One idea is to ask the stakeholders if the organizational changes required for the project are realistic


• Remember to use Subject Matter Experts, SME, when needed in order to ensure that all systems impacted by the project are catalogued


• Take a careful look at the stability of the technology. Ask yourself whether or not the identified technical requirement are based upon technology that is operationally stable, available, and affordable.

Architectural Factors for choosing a technical architecture

When looking at buy or build solutions, a couple of architectural considerations are:

• What technology has the customer already invested in?


• What vendor relationships has the customer alread established


• What is the current and planned skills inventory within the IT function?


• What is the comfort level of the staff with the current capability?


• How much of the system's current capacity is being used?


• Is the customer's operation centralized or decentralized?


• What is the customer's sensitity to capital investment, operating costs, scalability, stability, and security?

Identifying a project opportunity

On the technology side of the industry, if you see an opportunity for improvement on a project. There are a couple of things that need to be explained when asking to change the directions.

First, an accurate measurement of the current conditions and circumstances that are based upon facts. With a clear statement of the opportunity.

A clear criteria of the resolved state, and what criteria will define success.

An analysis of the people, platforms, and process issues involved in moving the opportunity through to completion including impact analysis.

And the benefits that are gained.

Including CF in a CSS page.

Sometimes, it is just beneficial to include cf code within a css file.

In order to do this first save the CSS file with a .cfm extension, for example style.cfm.

Next, at the top of the css file, add the following cfcontent tage

<cfcontent type="text/css; charset=ISO-8859-1">

The page is then processed by CF, but since the cfcontent sets the page to be served with a text/css mime-type resulting in browsers recognizing the page as css.

Finally, to include the file within your cfm page as follows

<link rel="stylesheet" href="style.cfm" type="text/css" />

A side note is to remember to escape the pound signs within the css page when necessary.

Scope_Identity, Ident_Current, & @@Identity

Working with a DB via CF is an easy thing. Primary Key assignment is an issue that goes to the heart of the interaction.

Alot of people know about Using @@Identity to return the key, however in SQL 2000 there are new functions in town to make life alot easier.

Sometimes, one can get unexpected results using @@Identity. The reason for this is that @@Identity returns the last identity value inserted. A clearer picture maybe found with Scope_Identity which returns the last identity value inserted in the current session and the current scope. Finally Ident_Current('tablename') yields the last identity value generated for a specific table in any session and any scope.

So lets go with this scenario, say you have an insert into tblEvent that cause a trigger to fire. This trigger as an identity insert on another tblEventHistory. So in CF you do the following query.

<cfquery name="qEventInsert" datasource="#Application.cn#">
Set nocount on;

insert into tblEvent ( EventDesc ,StartDate ,EndDate, Owner )
values ( <cfqueryparam value="#Trim(variables.EventDesc)#" cfsqltype="cf_sql_varchar">,
<cfqueryparam value="#CreateODBCDate(variables.StartDate)#" cfsqltype="cf_sql_date">,
<cfqueryparam value="#CreateODBCDate(variables.EndDate)#" cfsqltype="cf_sql_date"> ,
<cfqueryparam value="#Trim(variables.UserName#" cfsqltype="cf_sql_varchar">)

select scope_identity() as EventID;
select @@identity as EventHistoryID;
Select Ident_Current('tblEvent') as LastInsertedEventID;

set nocount off;
</cfquery>

@@Identity would return the trigger value in tblEventHistory

scope_identity returns the pk value in tblEvent for this event.

Ident_Current is the last identity value of the tblEvent for all sessions of the application.