Mitigating Risk on EHR Projects

Enterprise software projects continue to be fraught with risk including unexpected costs, significant delays, and end results that fail to deliver on expectations. EHR’s are no exception and the VA’s large-scale EHR implementation appears to be yet another example of the headwinds that plague enterprise software implementations. The VA EHR replacement project was originally inked at $10 Billion and has already ballooned to $16 Billion barely two years into the decade long project. Apparently, the original budget failed to account for the significant amount of internal and 3rd party consultant resources related to process re-design, project management, and infrastructure improvements required to pull off this significant enterprise project.

This comes as no surprise to those of us who implement EHR projects for a living, but it does highlight the gaps between what organizations often times think a software vendor will do, and what the software vendor is actually contracted to do. 

Planning for Success

One of the metrics that Gartner points to as a key ingredient in mitigating software implementation risk is upfront planning. According to Gartner’s estimates, pre-planning which includes specifications, workflow analysis, change management, and process re-design should account for up to 40% of the total cost of the project. In addition, project management and oversight, vendor management, overall system architecture and integration, change management, as well as ongoing process and workflow revisions accounts for another 15-20% of total project cost related to internal and 3rd party resources above and beyond the software vendor themselves. 

Let’s go back to our VA project and revisit the math. The original contract which was assumed to performed by the software vendor was $10 Billion. According to the math suggested by Gartner as well as indicated by our own experience, there’s an additional 60% of costs that could have been be reasonably anticipated to appropriately resource the project. What’s 60% of $10 Billion? Right, the exact increase requested by the VA or $6 Billion. 

Experience

Successful software projects require reasonable expectations and adequate resources no matter how you slice the monetary pie. The vendor that provides your solution is a key ingredient and understands the mechanics of their own software system very well. But it’s just one component of a 3-legged stool of success which includes internal organizational resources and SME’s, expert 3rd party resources to add bandwidth, provide expert guidance, and navigate project challenges, and the right vendor software package to solve the right problems. 

Savvy organizations understand that they only implement one EHR system every 5, 10 or maybe even 15 years. Over that same time frame, an experienced consulting firm will have implemented 100, 200, 300 or more. When an EHR project reaches go live and then enters into the stabilization period, there’s really only one outcome an organization wants; namely that the project was successful i.e. met the overall objectives and budget expectations, and ultimately improves the quality of care and workforce experience on an ongoing basis. 

In our experience, you can significantly increase your odds of success by simply resourcing the project correctly and setting realistic expectations from the beginning. 

Thad Dickson, HCISPP, MCTS

CEO

Xpio Health

http://xpiohealth.com