The Fellowship is:

• Focused on building innovation as a process and a capability, both personally and organizationally;
• A phased approach to innovation that allows Fellows to reflect and learn (in immersion sessions and webinars) and to accelerate realization of results through $1,000,000 projects;
• Rich learning and networking through diverse views, experiences and disciplines of Fellows;
• Learning that is shared by Fellows to strengthen their organization's capability to innovate and improve outcomes.

Participation details:

• The investment for the Fellowship program is $20,000 (the Fellowship program fee will be discounted for members of partner organizations), plus travel costs;
• Program fee is both an investment in your organization and your career;
• Application deadline is July 16.

Participants will be mentored by a group of nationally recognized leaders including: Barbara Balik, EdD, RN; Jack Gilbert, EdD, FACHE; Kathy Malloch, PhD, MBA, RN, FAAN; Tim Porter-O'Grady, DM, EdD, FAAN; Barry Silbaugh, MD, MS, FACPE; Donna Sollenberger, EVP and CEO University of Texas Medical Branch; and David Webster, partner, IDEO.

For more information and to apply, visit the Transdisciplinary Consortium for Innovation Leadership in Healthcare website or contact Jack Gilbert at jack.gilbert@asu.edu.

HHS Secretary Kathleen Sebelius announced the first batch of organizations for Health Care Innovation awards. Made possible by the Affordable Care Act, the awards will support 26 innovative projects nationwide that will save money, deliver high quality medical care and enhance the healthcare workforce. The preliminary awardees announced today expect to reduce health spending by $254 million over the next 3 years. 

The new projects include collaborations of leading hospitals, doctors, nurses, pharmacists, technology innovators, community-based organizations, and patients’ advocacy groups, among others, located in urban and rural areas that will begin work this year to address health care issues in local communities.  This initiative allows applicants to come up with their best ideas to test how we can quickly and efficiently improve the quality and affordability of health care.

Projects include:

Emory University’s collaboration with area health systems to train health professionals and use tele-health technologies to link critical care units in rural Georgia to critical care doctors in Atlanta hospitals.  This project aims to save money and improve the quality of care by reducing the need to transfer patients from rural hospitals to critical care units in Atlanta;

Courage Center, which is a program in Minneapolis-St. Paul serving adults with disabilities and complex medical conditions. The grant will enable Courage Center to save money and improve the quality of care by creating a patient-centered medical home focused on highest-cost Medicaid patients;

A University Hospitals of Cleveland initiative to increase access and care coordination for children beyond the walls of the doctor’s office. This initiative aims to save money and improve the quality of care by extending the expertise of an elite children’s hospital to local pediatric practices treating children with complex chronic conditions and behavioral health problems with physician extension teams and tele-health.

Preliminary awardees were chosen for their innovative solutions to the healthcare challenges facing their communities and for their focus on creating a well-trained healthcare workforce that is equipped to meet the need for new jobs in the 21^st century health system.

Today’s awards total $122.6 million. The Center for Medicare and Medicaid Innovation within the Centers for Medicare & Medicaid Services at HHS administers the awards through cooperative agreements over 3 years.

To learn more about other innovative models being tested by CMS’ Innovation Center, please visit:http://www.innovation.cms.gov/.

Although California is famous for its agriculture (oranges, grapes, roses), in the city of Irvine, at the University of California, they soon may be famous for growing informatics nurses.

In November 2011, UC Irvine Healthcare introduced an innovative program to recruit nurses into the field of nursing informatics. Through the combined sponsorship of the chief nursing officer, Karen Grimley, and the chief information officer, Jim Murry, 13 new nurse informaticists have successfully completed the first program, reports Charles Boicey, MS, RN-BC, CPHIMS, information solutions architect, information services, UC Irvine Health.

It's not uncommon for those who make the transition from clinical nursing to nursing informatics to struggle with the "brave new world" of information technology. Many who have made such a transition report that the industry and this specialty are "a different world" with a language and set of protocols vastly different from what they had previously experienced in clinical nursing practice.

The program at UC Irvine Healthcare provided 60 days of formal classroom education, industry specific on-the-job training and several months of mentoring to experienced nurses, who prior to this had no previous information technology experience. The first candidates accepted into the program included RNs with clinical practice backgrounds in ICU, pediatrics, medical-surgical, oncology, orthopedics, transplant, NICU, obstetrics, quality, case management and research. Content for the program's classroom training was modified from the Health IT Workforce Curriculum Components and covered such topics as: role transition, HIPAA, meaningful use, order sets, training on the vendor system, system configuration, Visio for workflow, ergonomics and clinical documentation.

Prior to this program's inception there were few established blueprints for successfully orientating and training newly hired informatics nurses which has resulted in many clinicians' inability to successfully make the transition.

A collaboration between nursing and IT utilizing a modified version of Health IT Workforce Curriculum to create a successful nursing informatics training program to "grow" the nursing informatics workforce and make the transition less painful is an example of an "innovation in nursing informatics."

The National Intitute of Standards and Technology has released its final guidance on usability of electronic health records. It has also launched a site where you can offer your opinion on the plans.

Nurses have a vested interested in this the final guidance, NISTIR 7804.  

NIST also launched a Wiki site (a website anyone can contribute to) as a way to offer collaboration among all stakeholders in developing tools for measuring and evaluating the usability of health IT systems.

There is a lot of talk about getting nurses "a seat at the table"; here is an open invitation. We hope to see frontline clinicians actively contributing to the wiki.

AONE (American Organization of Nurse Executives) has released a position paper on the Nursing Informatics Executive Leader.

This document utilizes the HIMSS Position Statement on Transforming Nursing Practice through Technology & Informatics as a foundation. Note the citations below: 

• "Technology will continue to be a fundamental enabler to the future care delivery models and nursing informatics leaders will be essential to transforming practice through technology."
• An essential ingredient is the inclusion at the leadership table providing budgeting, oversight and strategic guidance to support not only nursing practice, "but the entire care delivery team in anticipating and adapting to changes in the healthcare environment bridging new care delivery models into clinical practice with the right technology solution."

This position statement, HIMSS' position statement, the IOM Report of the Future of Nursing Report and many other notable documents are demonstrating the role and power of nursing and nursing informatics professionals that "together, nurses and nursing informatics must lead, and be visible, vocal and present at the table to achieve healthcare delivery transformation" (HIMMSS).

Informatics leaders, practitioners and other members of the healthcare community will convene June 23-27, 2012, in Montreal, Canada, for the 11th International Congress on Nursing Informatics (NI2012). The Congress gives participants from across the world a forum to discuss the impact of informatics on patient care improvement, global health, professional practice, health policy and research.

NI2012 is a rare opportunity for nurses, midwives, community health workers and scientists to participate in a program built around the world's most knowledgeable and highly trained informatics professionals. The meeting, which generated paper, poster and panel submissions from 38 countries, includes sessions that represent viewpoints from multiple regions and continents. Select sessions will be simultaneously interpreted in Spanish.

"If you are working to improve the health of your community or your population and you are using information, communications technology or informatics, you should come to the meeting," said Patricia Abbott, PhD, RN, NI2012 Chair, and an associate professor of informatics and co-director of the WHO Collaborating Center at Johns Hopkins University.

Each day features a host of distinguished speakers beginning Sunday, June 24, with Judith Shamian, RN, PhD, LLD, DSci, FAAN, President and CEO of the VictorianOrder of Nurses of Canada and President of the Canadian Nurses Association. She will discuss informatics as it relates to global health and the central role informatics can play in building healthy communities and sound health policy. Shamian will also offer her perspective on how informatics can contribute to improving healthcare practices. On Tuesday, June 26, Vic Strecher, MPH, PhD, a renowned speaker recently featured on TedMed, will discuss eHealth as a mechanism for encouraging healthy behaviors in his keynote address, and on Wednesday, June 27, Patricia Flatley Brennan, RN, PhD, will serve as the closing keynote speaker. Brennan is a professor of nursing and industrial and systems engineering at the University of Wisconsin-Madison.

Among other highlights, the Congress features a plenary panel, "Nursing Informatics: Perspectives from the Americas," on Monday, June 25. Panelists are: Silvina Malvares, Pan American Health Organization/World Health Organization; Pedro Urra Gonzalez, Havana University; Erika Caballero, Universidad Central, Santiago; Carol Hullin, World Bank/IMIA-LAC; Charles Friedman (moderator) University of Michigan.

"Our Congress theme, Advancing Global Health Through Informatics, reflects the team-centered and interdisciplinary approach that is required to truly transform the health of our nations, our communities and our patients," Abbott said.

Attendees will have the chance to engage in interactive panel discussions led by informatics professionals who will share their expertise and discuss advancements in the field. Panel presentations will cover a variety of topics, including developing patient-centered interventions for e-health applications, understanding international perspectives on nursing informatics and using mobile health technology to support informatics innovations.

The Congress is sponsored by the International Medical Informatics Association-Nursing Informatics SIG (IMIA-NI SIG), and hosted by AMIA, the American Medical Informatics Association. More than 30 volunteers are working together on multi-national committees to organize the event.

For more information or registration details, visit http://www.ni2012.org/.

Change is a constant within the healthcare information systems (HIS) environment. Although there is a wealth of theory related to change few tools currently exist to deal with real-world problems related to change such as: lack of physicians' buy-in to CPOE and clinicians remaining stuck in a mindset of "we've always done it this way, why change?"

Brenda Kulhanek, PhD, RN-BC, CPHIMS who currently practices as a performance improvement specialist acknowledges: "There really are a lack of tools and models to effectively do this work ... Part of the problem is everyone and everything is painted with the same brush ... Often when an error or problem occurs the same solution is utilized for this problem as was applied to the previous problem.

"What does not occur is a thorough individualized investigation of what really is going on, what is being done incorrectly. Perhaps it's an educational issue - people were not trained properly. Maybe it's an environmental barrier - no room on the mobile cart to write when needed or carry supplies, etc."

Kulhanek holds a master's degree in nursing leadership and management and a doctorate in performance improvement combined with many years of experience providing training to multiple organizations across the U.S. in health information technology. This has all contributed to her developing a tool to operationalize change management within HIT. "Hospitals and healthcare organizations are very political environments, especially when it involves implementing an EMR. IT changes the social structure of an organization. In the past the doctors had the power. Changes resulting from implementation of new technology, workflows and care practices frequently turn the previous power structures upside down giving others more of a voice."

Including the organization's mission statement in the project charter of the HIT initiative is but a one- time fix. Post the initial go-live change requests do not cease but should be expected to continue, if not increase. This leaves those who have to decide on the change requests without a best practice methodology and the tools needed to objectively prioritize the changes. "Your technical people may not understand the significance of clinically related requests and your clinical staff may not be able to fathom the nuances of technical change requests," says Kullhanek.

How once a performance gap is identified do we connect the solution to the organizations' mission? Does this request align globally with the organizations' strategic plan? Does it represent a true enhancement? Or does it only reflect the agenda or personal preference of one person, department or user segment? Kulhanek has developed an interdisciplinary change management methodology and tool that does all the above.

Additional benefits of using this change management tool include: "educating the clinical end-users on how to think organizationally and come out of the silos of their individual disciplines or departments. It gets people to thinking globally and functioning more as a team," Kulhanek says.

Every organization has its mission, use of a real-world change management tool can help a nurse translate what she/he does at the bedside to how work supports the mission. This is an Innovation in Nursing Informatics!

Perhaps one of the key's to MGH's success is the creation in 2006 of the role of director of clinical informatics. Originally the role reported jointly to the chief administrative officer (CAO), Eric Moll and the chief operations officer (COO), Eileen Branscome, MBA, RN.

When asked why the role was created, Kelly Nettle, RN, BSN, director of clinical informatics at MGH said: "To ensure that nursing has a voice in the technological aspects of the electronic medical record since their documentation is so critical to the patient's care." Nettle sees herself as a bridge between not just nursing but all departments within the hospital: health information management (HIM), the business office, providers, clinicians and IT. Being that "bridge" to successful tools for use by the end users.

Currently the director of clinical informatics' role reports to the chief information officer (CIO), Tom Hornburg whom Kelly reports as: "Recognizing that clinical informatics is a very strategic part of IT."

Nettle believes that the innovations and successes that the department of clinical informatics and MGH has experienced are also due to leadership acting as active agents of change. "Reasons why we are successful? Because the CAO, COO and the CIO believe in what we as bedside clinicians do. They have facilitated the changes by giving us the tools, provided us with the training resources, allowing clinicians and staff to evaluate what's out there in the market and taking our recommendations seriously. Four years later and I am still so excited about my role and to come to work!"

Nettle also points to the family orientated culture of MGH that translates to a "whole team" effort between non-clinical IT staff members and the clinical informatics staff. There is also a very high level of participation by and collaboration with the medical staff lead by Dean Gushee, MD, medical director.

Speaking of current innovations, Nettle reports: "We are using visual smart boards for not just nursing but multiple disciplines. Visually the boards help brings information to one place, increase staff efficiency and decrease the time it takes to find what the staff needs.

"We recently implemented a new nursing board that displays the most current vital signs, recent critical lab values - glucose, potassium and H&H. It gives our clinicians real-time data immediately. They don't have to thumb through a chart, just click on that data and see it immediately.

"The other boards we have are workflow specific - such as the one for the lab that let the lab staff know when a patient has a central line so that they don't waste valuable time going to that patient's room - because the nurses will draw the blood.

"Our HIM coders were having a difficult time finding exactly where nursing was documenting certain items. The department of clinical informatics said: ‘You tell us what it is you need to find and let us help you find it.' Then our team worked with the vendor to configure the smart board to display exactly the particular documentation needed to by the coders on the particular patient thereby eliminating unnecessary searching.

"Great thing about the smart boards is that they allow the information to display for 13hrs instead of making the clinician again have to log back on."

Having strong leadership, mandating clinical involvement, working collaboratively and giving staff real- time tools that streamline their workflows are examples of innovations in nursing informatics.

Too often, we hear about the challenges and failures occurring within healthcare informatics: resistance to change, failed implementations, scope creep, gaps in quality, silos of data, poorly designed systems - even clinical information applications that cause more harm than good. Beginning with this post, I will be focusing on the successes and innovations in nursing informatics that are occurring throughout the United States within clinical informatics and the healthcare information systems arena.

Roles and Responsibilities

Although a project is a "team effort" the roles of project owner, champion and stakeholders have unique and specifically designated responsibilities.

The role of the project owner is usually filled by a member of the C suite, a VP or department head. If the project is a CPOE implementation the project owner may be the chief medical officer (CMO), chief medical informatics officer (CMIO) or there may be joint or co-project owners such as the CMIO and the VP of patient care or chief nursing officer (CNO). If the project is limited to an application that supports one department (radiology or surgery) the project owner may be the director of surgery or the manager of radiology. In the role of project owner the individual or individuals are expected to:

• Provide leadership, especially related to unresolved issues, final decision making, and authority to approve needed policies and procedures to support the project;
• Ensure that the project has the needed funding and resources.

The project champion can also be the project sponsor but more commonly the project champion is a peer of the clinicians most impacted by the clinical initiative. If it's a CPOE initiative the project champion is a physician who is viewed as an official or unofficial leader of his/her peers. The project champion is expected to:

• Act as an agent of change and encourage adoption;
• Ensure domain- discipline-specific input is reflected within the project planning.

The primary stakeholder in all clinical initiatives should be the patient. A stakeholder is defined as anyone who has a "stake" in the outcome of the project and those who will benefit from the successful completion of the project. Patients, project owners, champions, board members, clinical and non-clinical staff, project work group members, build teams and ad hoc committee members are all project stakeholders and thus responsible for:

• Actively participating in and contributing to their designated committees, work groups and teams.

Risks vs. Issues

Finally, all projects experience risks and issues. A risk can be defined as: a complex issue that has a significant potential to detrimentally affect one or more of the project objectives. Anything that could cause the project to fall short of established project targets. An issue can be defined as any problem that needs to be corrected but is not a show stopper.

Here's to wishing that none of your projects' "issues" become "risks." Good luck in managing your projects!

Patient "infotainment" systems are one means by which hospitals can engage patients and their families better in the healthcare process. These systems use TVs or computer monitors to give patients access to a variety of entertainment, informational or educational content. Sometimes the display is mounted on a swing-arm near the bed, in which case the patient controls the system through buttons on the TV or by a touch-screen. Alternatively, when the display is mounted on the wall across the room, the patient usually interacts with it through the pillow speaker that is also part of the nurse-call system.

Besides entertainment (TV, movies, Internet, games), these systems offer a wide variety of personalized information about the hospital, the specific team of care-givers for the patient, treatment plans and options, post-discharge instructions, etc. Patients can indicate preferences for meals, learn more about their medical condition and provide feedback on their hospital experience.

A growing number of these systems are being integrated with patient medical records, laboratory results and other clinical information specific to the patient. Some of them even offer "tele-visitation" capabilities by which family members may send pictures, messages and e-cards for viewing by the patient.

Variations of these patient infotainment systems can be used in extended-care facilities or even in the home. Such solutions are especially promising for improving the quality of life and independence of seniors, who can communicate with friends and family, receive personalized health information & recommendations, set personal alarms as reminders for medication, etc. Furthermore, family and healthcare professionals can check in remotely, to confirm the seniors are doing well. Ultimately, these systems could become the foundation for telemedicine, when integrated with real-time telemetry of patient vital statistics, electronic medical records and/or personal health records.

It seems likely the convergence between patient infotainment systems and clinical information will only increase in the next few years. Where do you see the opportunities -- and the pitfalls -- for patient infotainment systems?

Critical to simulation is the suspension of disbelief, which is defined as, "a willingness to suspend one's critical faculties and believe the unbelievable." The more realistic (or high fidelity) the scenario, the more learners can immerse themselves into the situation.

At UCSF Medical Center, we are beginning the educational development of staff in preparation for the transition from a paper-based medication administration record (MAR) to an electronic MAR or eMAR with barcode scanning. This is equivalent to going from crawling to running, bypassing learning how to walk.

While the transition to an eMAR that can be viewed by all clinicians is a positive step for technology and an integrated enterprise solution for all - not to mention it is the right thing to do for our patients and their families -the implementation requires great caution. This transition must not only be smooth, but cannot compromise patient safety related to medication administration errors. To address this, we decided the traditional methods of online learning modules and classroom training would be supplemented by mandatory simulation learning as well.

The simulation team has developed a simulation area with patient rooms, medication areas and separate debriefing rooms. Using high fidelity manikins that possess the ability to display various cardiac rhythms, physiological traits (e.g., cynanosis, tears, etc.), speech responses to questions controlled by operators, as well as many other features, we have created a realistic yet safe environment for clinicians to simulate medication administration in the new world, with eMAR and barcoding.

Focusing on the majority of the medication workflows seen in acute care, critical care and perioperative areas of both adult and pediatrics, clinical scenarios have been created to provide learners the ability to simulate administration of:

• scheduled medications
• insulin meds, requiring 2 RN independent checks
• IV fluids, including boluses
• PRN or as-needed medications
• emergently needed medications

Each class allows four learners to be facilitated by one instructor. Simultaneously, four other learners will engage in a facilitated viewing, allowing them to watch the other four learners perform medication administration. The two groups then change places and a group debriefing of the eight learners is led by the two facilitators at the end of the 2-hour session. During this debriefing, annotated video clips are pulled up for review and discussion by the group.

The aim is to highlight best practice and to underscore the critical workflows associated with safe medication administration. It is in the debriefing sessions, similar to nursing school clinical shift debriefings, where the discussion and critical thinking about the experience occurs.

While the majority of the published research studies have addressed the use of simulation with pre-licensed clinicians for education of clinical scenarios², our simulation is primarily focused on education of licensed nurses, respiratory therapists and pharmacists. In addition, we are using the technology to actually educate about technology. If simulation is proven effective to teach clinical skills, would it not be successful to teach technical skills around barcode medication administration and the eMAR as well?

Student perceptions of simulation in a study by Partin et al. found three main themes contributing to the success of student approval. These were:

• a nonthreatening environment
• enhancement of learning
• feeling prepared for practice²

Without a doubt, this trifecta of education requires time and resources, but I believe a Chinese Proverb sums it up best: "Tell me and I will forget; show me and I may remember; involve me and I'll understand." --anonymous

References

1. Jeffries, P.R., et al. (2011, September). Multi-center development and testing of a simulation-based cardiovascular assessment curriculum for advanced practice nurses. Nursing Education Perspectives, 32, 5, 316-322.

2. Partin, J.L., et al. (2011, June). Students' perceptions of their learning experiences using high-fidelity simulation to teach concepts relative to obstetrics. Nursing Education Perspectives, 32, 3, 186-188.

Sandy Ng is a staff member at UCSF, however, the views and opinions of Sandy Ng expressed herein do not necessarily state or reflect those of the Regents of the University of California, UCSF, UCSF Medical Center, or any entities or units thereof.

The Project Manager

As I wrote in Project Management Part I - The project manager is more than a manager of the numerous tasks that make up a healthcare information systems project. He/she has ultimate responsibility for ensuring that the project is managed well.  

An experienced project manager works with project team members to ensure a successful, on time and within budget go live. He/she demonstrates knowledge of project management methodology, organizational skills; possess strong group facilitation skills, provides direction and support for decision making; enables timely and effective communication among project stakeholders.

The Project Charter

An underutilized tool, the project charter, is the first step of project planning. The project charter defines the approach, objectives and scope of the work to be completed. The charter is a critical element for initiating, controlling, planning, executing and assessing the project.  It should be utilized as the single point of reference for project scope, objectives, goals, resource estimation and work plan. In addition, it serves as the written agreement  among the project work groups, stakeholders, project champion(s) and project sponsors, outlining  what will be delivered according to the scope, project assumptions, time constraints, budget  and requirements  agreed upon for the project.

Utilized in the way a cook follows a recipe or a sailor employs a compass, the project plan is referenced to obtain a high-level overview, to accent details, remind us of what the project is about, what the originally agreed upon methodology is, why it is being implemented and to continue to steer the charted  course.   

Not Your Mother's IT/IS Project

Today's successful clinical information systems projects have in common executive leadership who (early on during the project initiation phase) stresses the importance of the project being identified as a clinical initiative NOT an IT project. Ownership of the project is given to clinical stakeholders by reinforcing the fact that this is NOT an IT/IS project but instead a "clinical initiative" with interdisciplinary participation, led by clinicians, to improve and support clinical practice and patient care delivery.

Having Some Skin in the Game

In addition to leadership empowering clinical stakeholders to take ownership of the project, a well-planned project includes identified success metrics not just organizational business goals. Metrics can be used (post project) to evaluate the success of the implementation.  Success metrics go beyond the traditionally identified business and strategic goals and objectives.  An example of a strategic goal is: "Improving safety, efficiency and quality of patient care, and services."  Success metrics on the other hand come from those who have a stake (stakeholders) in the successful outcome of the project. Success metrics are specific and measureable.   Since the project is a clinical initiative, led by clinicians the success metrics should come from the clinical stakeholders thereby giving them some skin in the game.  An example of a success metric is: Improved safety, efficiency and quality of patient care, and services as demonstrated by:

• Decreased prescribing and transcription errors (from Pharmacy, Medical Practice and Nursing)
• Increased legibility of orders and documentation (from HIM, Nursing, Pharmacy and QI)
• Improved compliance in timely signing and dating of orders (from Medical Practice, Nursing, HIM, Pharmacy and QI)

Next: Project Management -Part III What Works (Continued)

From my own experience (good and bad), and from that of others in the industry, here are some critical factors that can "make or break" a successful CPOE implementation:

Executive Sponsorship - Success or failure begins at the top of the organization. The project must be recognized, supported and funded as a critical, strategic initiative. The specific system must be carefully matched to the particular needs, capabilities and strategic vision of the hospital. Professional development and continuous improvement of clinical practices must be re-emphasized as cultural values and behavioral norms. The unmistakable, consistent message must be that CPOE is a positive and mandatory step forward for the organization and its members.

Identified Champions - Specific individuals (preferably volunteers, but assigned if necessary) must be identified as key contacts for various areas (i.e., cardiology, ob/gyn, pediatrics, radiology, nursing, pharmacy, etc.). Both champions and cheerleaders, these individuals will be focal points for information to, and from, their peers. They will ensure that order sets, policies, etc. are appropriate and inclusive to their respective responsibilities and activities. They can also assist in demonstrating, training and encouraging others, speeding the acceptance and proficiency with the system.

Realistic Redesign - CPOE both necessitates, and facilitates, changes in the workflows, thinking processes, and behavior of all clinical departments. At the same time, when and as possible, the specifics of the CPOE implementation should be tailored to the organization's needs. This "meeting in the middle" must be acknowledged and demanded from the outset. It should be embraced as an opportunity for improvement, not dreaded as a disruption. Ultimately, CPOE is an organizational and clinical change-initiative, not "just an IT project."

Project Management - Major undertakings don't just happen on their own: plan the work, and work the plan. Meticulously inventory and analyze requirements, constraints and resources; identify timelines with multiple intermediate milestones; hold regular progress reviews; realistically assign responsibilities and deadlines; and hold individuals accountable for those deliverables.

Ongoing Support & Communication - The "go-live" of a clinical implementation is not "the end" but a beginning. Inevitably, problems, issues and questions will arise. The first several days of widespread use should be heavily "front-loaded" with support staff to receive, to analyze and to address such reports from users. The flexibility, responsiveness, empathy and respect shown in this phase - by all involved - will set the tone for ultimate acceptance or resentment of the system.

What are some of your own horror stories - or success stories - with clinical-system implementations?

Project Management Basics

A Guide to the Project Management Body of Knowledge (PMBOK) defines a project as "a temporary endeavor undertaken to create a unique product or service." A project has a specific beginning and end as opposed to ongoing operations.

Ideally every project results in a "deliverable", a tangible product or service intended as the ultimate goal of the project. The "deliverable" could be the implementation of a Barcode Medication Administration System or the successful Go Live of a clinical documentation module. You may also hear "deliverables" plural, used to refer to tasks that someone is responsible for, as in: "The project consultant's deliverables are to 1) act as a subject matter expert and 2) ensure discipline specific domain knowledge is included in the project."

A project milestone differs from a deliverable in that a milestone marks a point in time (or a measurement) of progress toward a goal. In a healthcare information systems project the "milestone" could be the project plan was completed on January 21. The deliverable would be the actual project plan.

To be avoided at all costs and as insidious as a scabies infestation is scope creep. Many a project failure can be attributed to a project that extended outside its intended boundaries or "scope." With complex healthcare information systems projects that threaten not to achieve deliverables or meet milestones how can such risks as scope creep, running over budget or out of time, within the constraints of limited resources be avoided?

The Project Manager

Yes, much is placed on the shoulders of the person assuming the role of project manager. More than a manger of the numerous tasks that make up a complex healthcare information systems project, the Project Manager is a leader, a facilitator and frequently one of the keys to a successful project completion.

Next, Project Management, Part II - What Works

Conferences can be local, national or regional. Some employers will pay, or supplement attendance, others will not. Finding a conference that meets your needs is worth the investment in your professional development, even if your employer cannot (or will not) assist. Use your electronic network to verify that the conference is valuable and worth the investment.

When attending a conference be sure to bring business cards. Even if you are not looking for a job, this will help establish connections. Ask for business cards (making notes and saving them) for future needs.

Take notes at user groups or conferences to reinforce and clarify what you've learned. Keep notes for future use and can share with others, including your peers at work (internal networking).

Thank the presenter and ask questions and make notes of the answer - most presenters really appreciate questions. Ask for business cards and ask questions during networking opportunities and poster sessions (if the conference has poster sessions) as well.

Dress professionally even if you are not looking for a job you want people to remember you positively - as a professional. This does not mean wearing a suit (unless you are presenting or looking for a job, or like to wear suits - I do), just being professional (not too casual). Sometimes adding a jacket or a dressier pair of shoes can dress up a casual look.

Virginia Tech has some excellent advice on when to dress "business casual" as well as guidelines. They are somewhat conservative, but an excellent start, especially when it is the first time you have attended a conference. A good friend once advised me that "it is better to over dress than under dress" (thank you Becky!). This is true for conference attendance, as well as a social event. About.com has some examples, and even the Wikipedia even has a definition of business casual.

What is your favorite conference for networking opportunities? What hints do you have?