Anticlue

HIMSS Sample RFP Documents

We all know the engaging process for RFP development. It takes a month or two to develop an RFP with the key participation from the selection team. If you haven't been through the process before, the HIMSS Enterprise IS Steering Committee's RFP Work Group has developed some sample RFP documents intent to be for the aquisition of a full Health Information System for the hospital acute environment. They cover all activities related to system procurement from corporate due diligence to selection criteria. The overall intent is as a guideline, and they can be found here.

ICD-10 is in the distance

The first of many announced deadlines has come out for the ICD-10 codes. For your information, ICD-10 is the new replacement code set for diagnosis and procedures in the healthcare industry. ICD-10 will provide great specificity leading to improved disease tracking. HHS announced on August 15th, the desire to have the ICD-10 Code Sets Effective October 1, 2011. Additionally, adopting the X12 standard, Version 5010, and NCPDP Version D.0 for Prescription Drug Programs. These are foundational components to an ICD-10 implementation.
A new item to add to your 3 year strategic plan, as it will encompass most of your revenue cycle systems.

Deming's Adaption of the 14 Points for Medical Service

Just came across this one today, and I wanted to share and keep it in a place I'll remember.

1. Establish constancy of purpose toward service.
   1. Define in operational terms what you mean by "service to the patient"
   2. Define standards of service for a year and hence 5 years
   3. Define patients whom you are seeking to serve
   4. Constancy of purpose brings innovation
   5. Innovate for better service
   6. Put resources into maintenance and new aids into production
   7. Decide whom the administrators are responsible to and the means by which they can be help responsible
   8. Translate this consistency of purpose to service to patients and the community
   9. The board of directors must hold on to the purpose
2. Adopt the new philosophy. We are in a new economic age. We can no longer live with commonly accepted levels of mistakes, materials not suited to the job, people of the job who do not know what the job is and are afraid to ask, failure of management to understand their job, and antiquated methods of training on the job, and inadequate and ineffective supervision. The board must put resources into this new philosophy, with commitment to in-service training
3. 1. Require statistical evidence of quality of incoming materials, such as pharmaceuticals, inspection is not hte answer. Inspection is too late and is unreliable. Inspection does not produce quality. The quality is already built in and paid for. Require corrective action, where needed, for all taks that are performed in the hospital
   2. insititute a rigid program of feedback from patients in regard to their satisfaction with services
   3. Look for evidence of rework or defects and the costs that may accrue.
4. Deak with vendors that can furnish statistical evidence of control. We must take a clear stand that price of services has no meaning without adequate measure of quality. Without such a stand for rigorous measures of quality business drifts to the lowest bidder, low quality and high cost being the inevitable result. Requirement of suitable measures of quality will, in all likelihood, require us to reduce the number of vendors. We must work with vendors so that we understand the producures that they use to achieve reduced number of defects
5. Improve constantly and forever the system of production and service
6. Restructure training
   1. Develop the concept of tutors.
   2. Develop increased in-service education
   3. Teach employees methods of statistical control on the job
   4. Provide operational definitions of all jobs
   5. Provide training until the learner's work reaches the state of statistical control.
7. Improve supervision. Supervision is the responsibility of the management.
   1. Supervisors need time to help people on the job
   2. Supervisors need to find ways to translate the constancy of purpose to the individual employee
   3. Supervisors must be trained in simple statistical methods with the aim to detect and eliminate special causes of mistakes and rework.
   4. Focus supervisory time on people who are out of statistical control and not those who are low performers. If the memebers of the group are in fact in statistical control, there will be some low performers and some high performers.
   5. Teach supervisors how to use the results of surveys of patients.
8. Drive out fear. We must break down the class distinctions between types of workers within the organization - physicians, nonphysicians, clcinical providers versus nonclinical providers, physician to physician. Discontinue gossip. Cease to blame employees for problems of the system. Management should be help responsible for faults of the system. People need to feel secure to make suggestions. Management must follow through on suggestions. People on the job cannot work effectively if they dare not offer suggestions for simplification and improvement of the system.
9. Break down barriers between departments. One way would be to encourage switches of personnel in related departments.
10. Eliminate numerical goals, slogans, and posters imploring people to do better. Instead display accomplishments of the management in respect to helping employees improve their performance.
11. Eliminate work standards that set quotas. Work standards must produce quality, not mere quantity. It is better to take aim at rework, error, and defects.
12. Institute a massive training program in statistical techniques. Bring statistical techniques down to the level of the individual employee's job, and help him to gather informiaton about the nature of his job in a systematic way.
13. Institute a vigorous program for retraining people in new skills. People mus tbe secure about their jobs in the future and must know that acquiring new skills will facilitate security.
14. Create a structure in top management which will push every day on the previous 13 points. Top management may organizae a task force with the authority and obligation to act. This task force will require guidance from an experienced consultant, but the consultant cannot take on obligations that only management can carry out.

Do we have the right mix of projects?

As we examine portfolio projects one of the key questions is did we launch the right mix of projects? Have we balanced our strategic initiatives with a smooth blend of operational endeavors with a smidgeon of mandatory requirements? One has to examine the portfolio from a holistic stance.

Normally, I like to breakout the demand into three groupings: capital, operational, and application support. Capital is the strategic demand, for capital requests are board approved endeavors and simply must be accomplished. Operational relates to departmental demand. These are the requests from the departments to automate business processes, and where a lot of the customizations, enhancements and variations to products are requested. Some refer to this as making a system sing, just be cautious on the time invested. Finally, there is the application support categorization. These are the routine demands to keep the systems running and up to date.

I've seem the gambit from currently striving for 100% strategic initiatives to 95% operational department requests. In my opinion your blend equates directly to the organizations usage of IT, is it a strategic enabler, or is it an operational expense of doing business. Typically, I refer to this gap between expense driven organization to a strategic enabler as the IT value chasm. Monitoring this metric is helpful to quickly identify the value of the IT organization. If you are crossing the it value chasm, the numbers should change in the direction of strategic enabler.

Priorization: The art of choosing what not to do

Let's take a couple of moments discussing how budget and resource capacity drives the need for a prioritization and selection process for IT project request. Over the years, IT has been viewed as a utility in some hospital environments, even has a logistics group. The problem is that there is simply not a backup generator to switch over for power, when there is an IT event. The response time for your disaster depends several factors. IT is the coordination of multiple pieces parts from the department's workflow to the wireless network. We are in a state of high interdependence.

This level of high interdependence causes simplistic requests at time to have the coordination of several individuals. For example, let's say we have an upgrade to an existing system. One way to do the upgrade is to just apply it to the production environment and hope for the best. Most professionals are now feeling that disconcerting shiver run up and down their spine. The common practice is to do the following.

1. Establish a test system which is a mirror of production.
2. Apply the upgrade
3. Test the upgrade for functionality, integration, data migration, and regression testing. I'd also recommend load testing.
4. Prepare the deployment package for the client deployment.
5. Train on new features/functions
6. Schedule Deployment
7. Deploy
8. Support / Resolve Issues
9. Move to production support.

Now within these steps, resources from client server, integration, desktop, and all impacted integration parts are needed along with the analyst responsible for the application. This simple upgrade has now become a 120 - 160 hour project. This project is operation keep the lights running work, necessary to keep operations current.

Add in a couple of items around procuring and installing equipment, redesigning workflow, and other testing components, and the project has increased in effort and duration. So if you have several departments or expansion, the truth is there aren't enough resources to support all requests. In a hospital setting, the demand for IT services always over exceeds the supply available.

One can definitely reprioritize the work efforts, and focus on the strategic must do activities at the cost of the operational duties. One item becomes lighter, the other item becomes fragile. The fragility equates into unexpected outages or poor service for needed operational support. Needless to say the tightline is tough to walk.

In order to resolve these obstacles, healthcare organizations need to change their tactic in the future. Strategic endeavors should be resourced with people and funding as a part of the investment capital request. Secondly a resource management plan should be in place looking at the current resource utilization, and the upcoming demand. Finally, capital commitments, should include continuing withdrawals when equipment is now at EOL. For example, the OR equipment should look to have an end of life and that a prior capital commitment to bring in the new replacement, versus competing in the capital allocations versus other strategic items. A key to success is establishing programs for the long haul as your key strategic enabler and then continuing to invest within the program as such with equipment and operational support resources as the benefits continue to be realized. Additionally along with the capital governance is the governance of the IT investments decided upon by senior leadership.

The key elements in establishing a PMO

Let's take a couple of moments to talk about the fundamentals. A PMO needs to have some basic elements in place to drive the project portfolio. These elements include:

• A process for project presentation, prioritization, and selection.


• An understanding of budget and resource capacity of the organization.


• An understanding of the project demand


• The ability to measure and report upon project portfolio success.


• A continuous improvement process with metrics indicating the value of the improvement.

Without these key element, the PMO will end up like so many others after 3 years with no measurable way to indicate business value - Disbanded and disbursed.

The Code Yellow Required meeting

Once of the key problems in today's environment of over meeting, is that it is very hard to get a group together within any reasonable amount of time. Key participants are normally booked or engaged in meetings ahead of time.

Therefore it becomes almost impossible to get the group together for decision making or problem solving. A practice we are starting to adopt is having a standing time, Tuesday Mornings 9 - 11 and Wednesday afternoons 1-4 for having Attendance Required Time Windows. All other meetings scheduled during these times are able to be cancelled or missed for the attendance of this meeting. It does help with project execution.