Heath care projects need high level of investment, diverse set of stakeholders, and comply with rigorous federal and state regulations, and standards.  In addition, project outcomes have direct impact on safety and well-being of patients. This speech focuses on challenges and opportunities in implementing Health care IT projects.  Also discusses strategies to adopt agile methodologies in health care industry.  Finally, highlights critical success factors in implementing Healthcare Projects successfully.    Learning Outcomes:   Understand characteristics of Healthcare projects  Learn challenges and opportunities in implementing Healthcare projects   Learn agile adoption strategies in Health IT  Learn and apply Critical Success Factors to improve project success

1. Critical Success Factors
in
Managing Health Care IT Projects
Dr. Kaali Dass, PMP, PhD.
Oct 4th 2017

2. Agenda
HealthCare IT Projects
Challenges and Opportunities
Agile IT in HealthCare
Critical Success Factors
Key Takeaways
Q & A

3. Cisco Confidential 3© 2013-2014 Cisco and/or its affiliates. All rights reserved.
HealthCare IT Projects

4. https://www.researchandmarkets.com/research/3t4fnw/healthcare
Improving Health Sector Efficiency: The Role of Information and Communication Technologies Generating Value from Health ICTs DOI:http://dx.doi.org/10.1787/9789264084612-4-en
Anderson, G. F., Frogner, B. K., Johns, R. A., & Reinhardt, U. E. (2006). Health Care Spending And Use Of Information Technology In OECD Countries. Health Affairs, 25(3)
Research and, M. (0009, June). Healthcare IT Consulting Market 2017-2022 - Focus on Strategy, Project Management, Integration, Migration, Security, Risk Assessment, Analytics, BPM, Regulatory - Research and Markets.
Business Wire
Healthcare Industry
 US healthcare spending at approximately 15% of GDP,
which is the highest in the world
 Around 85% of US citizens have health insurance
 Over the next 15 years EHR efficiency and safety savings
$371 billion in US Hospitals
 The Global Healthcare IT Consulting Market is Expected to
Reach USD 45.42 Billion By 2022 from USD 18.38 Billion in
2017, at a CAGR of 19.8%

5. Project Characteristics
Comply with
legal
requirements
Comply with
legal
requirements
High Level of
Accuracy &
Security
High Level of
Accuracy &
Security
Integrate with
multiple
organizations
Integrate with
multiple
organizations
Multiple
Standards
Multiple
Standards
Cost
Containment
Cost
Containment
Quality of Care
and Safety of
Patients
Quality of Care
and Safety of
Patients
Diverse set of
stakeholders
Diverse set of
stakeholders
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732244/#bib14
Cucciniello, M., Lapsley, I., Nasi, G., & Pagliari, C. (2015). Understanding key factors affecting electronic medical record implementation: a
sociotechnical approach. BMC Health Services Research

6.  Health Information Technology for
Economic and Clinical Health
(HITECH) Act of 2009
 Health Insurance Portability and
Accountability Act (HIPAA) of 1996
 Privacy Rule – Protect Medical
Records
 Security Rule – Secure all
information (Eg. Storage and
Transmission)
 Electronic Health Record Standards /
Certification Criteria
 Digital Imaging and Communications
in Medicine (DICOM)
 Health Level Seven (HL7): Provides a
standard protocols for exchange,
management and integration of
clinical and administrative electronic
health data
 Payment Card Industry Standards
Regulation and Compliance
LegislationLegislation Regulations / StandardsRegulations / Standards
Source: https://www.healthit.gov/policy-researchers-implementers/health-it-legislation

7. Health IT Security
Sources: Cisco 2017 Midyear Cybersecurity Report, Pecci, A. (2017)
Healthcare data breaches up 40% since 2015. Healthcare Leadership Review, 36(3), 13-14 || Foley, M. (2017). HIT in 2017 and for the long haul. Health Management Technology, 38(2), 6-13
Your Electronic Medical Records Could Be Worth $1000 To Hackers, retrieved from https://www.forbes.com/sites/mariyayao/2017/04/14/your-electronic-medical-records-can-be-worth-1000-to-
hackers/#1c253c5e50cf
https://resources.idgenterprise.com/original/AST-0185342_eFax_Corporate_White_Paper_-_Healthcare_IT_Cybersecurity_Update_2017.pdf
Value of healthcare records on the black market
is 10 to 20 times the value of credit card data
Value of healthcare records on the black market
is 10 to 20 times the value of credit card data
Business email
compromise
US$5.3 billion was
stolen
10/2013 to 12/2016
Business email
compromise
US$5.3 billion was
stolen
10/2013 to 12/2016
Ransomware
US$1 billion
2016
Ransomware
US$1 billion
2016
Cybersecurity
Projects
$90 billion to $113
billion
2017 - 2020
Cybersecurity
Projects
$90 billion to $113
billion
2017 - 2020
US Cyberattacks
Increased by 63%
Year-over-Year
US Cyberattacks
Increased by 63%
Year-over-Year

8. Breach Level Index
Source: http://breachlevelindex.com/

9. Top 10 Healthcare Cyberattacks in 2016
Source: Houlding, D. (2017). How do your cybersecurity efforts stack up?. Health Management Technology, 38(2), 26-27.
https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf
1. Banner Health: Approximately 3,620,000 patient records were breached, making this the single largest
healthcare data breach reported in 2016.
2. Newkirk Products: Approximately 3,446,120 records were potentially compromised.
3. 21st Century Oncology: Approximately 2,213,597 former and current patients were affected.
4. Valley Anesthesiology Consultants: Potentially breached during an ongoing cyberattack that 82,590
records were affected.
5. Peachtree Orthopedic Clinic: 531,000 patients of a cyberattack that had compromised their protected
health information.
6. Central Ohio Urology Group: Cyberattack that affected 300,000 patients.
7. Southeast Eye Institute, P.A.: Suffered a breach that impacted 87,314 individuals.
8. Medical Colleagues of Texas: Affected approximately 68,631 individuals.
9. Urgent Care Clinic of Oxford: A breach affected Approximately 64,000 individuals.
10. Alliance Health Networks: Protected health information of 42,372 patients being exposed for a period of
30 months.

10. Why Health Care IT projects are different?
Relationships
(Physicians, hospitals,
patients, and insurers)
Relationships
(Physicians, hospitals,
patients, and insurers)
Dominated by
external stakeholders
Complex Environment
Dominated by
external stakeholders
Complex Environment
Lack of standard
protocols
In exchanging patient
data with external
sources
Lack of standard
protocols
In exchanging patient
data with external
sources
High Focus on
Patient Care & Safety
vs
Profit
High Focus on
Patient Care & Safety
vs
Profit
Privacy & SecurityPrivacy & Security
Resistance to Radical
Changes
Resistance to Radical
Changes
Source: Ben-Zion, R., Pliskin, N., & Fink, L. (2014). Critical Success Factors for Adoption of Electronic Health Record Systems: Literature Review and
Prescriptive Analysis. Information Systems Management, 31(4), 296. doi:10.1080/10580530.2014.958024

11. Cisco Confidential 11© 2013-2014 Cisco and/or its affiliates. All rights reserved.
Challenges and
Opportunities

12.  Interoperability
 Healthcare Consumerism
 Telemedicine
 Wearable Sensors
 Big Data
 Interoperability
 Healthcare Consumerism
 Telemedicine
 Wearable Sensors
 Big Data
 Improved Patient Care
 Improved Patient Safety
& Awareness
 Cost Efficiency
 Prevention
 Prediction
 Improved Patient Care
 Improved Patient Safety
& Awareness
 Cost Efficiency
 Prevention
 Prediction
Source: 2016: Opportunities and Challenges in Health Care by Nancy Finn
http://healthcare.mckinsey.com/enabling-healthcare-consumerism

13. Complex / Diverse set of Stakeholders
Physicians
Insurance
Companies
Patients
Federal / Local
Regulatory
Agencies
Employees
Pharmacies
Labs
Stakeholders

14. Source: Rouse, W., Boff, K., Sanderson, P., & Aarts, J. (2011). Towards safe information technology in health care. Information
Knowledge Systems Management, 10(1-4), 335-344.
Risks & Mitigation
Organizational PurposeOrganizational Purpose
Development & Integration
Errors
Development & Integration
Errors
Implementation Errors /
Dependency
Implementation Errors /
Dependency
Human interaction / UIHuman interaction / UI
Leadership CommitmentLeadership Commitment
Development Standards / QA
Best Practices
Development Standards / QA
Best Practices
Implementation
Methodologies
Implementation
Methodologies
Reflective Design / TrainingReflective Design / Training

15. IT Driven Transition / Transformations
Ref: https://blogs.cisco.com/healthcare/at-the-security-cross-roads-of-health-care-reforms-and-ioe-6-health-care-it-transitions?dtid=osscdc000283

16. Transformation Challenges
Leverage Change Management Models like: Lewin, Kotter, ADKAR
Source: BOWERS, L. A. (2015). FEATURE. Secrets to EMR Success. Long-Term Living: For The Continuing Care Professional, 64(2), 34-37.
Leadership
Participation
Leadership
Participation
Infrastructure
and Support
Infrastructure
and Support
Process to
switch from
Paper to
Electronic
Process to
switch from
Paper to
Electronic
Diverse
Stakeholders
Diverse
Stakeholders
Dual
Structure
Admin &
Clinical
Dual
Structure
Admin &
Clinical

17. Cisco Confidential 17© 2013-2014 Cisco and/or its affiliates. All rights reserved.
Agile IT in Health Care

18. Agile Vs Waterfall
Release
Features
A + B + C
Test
Features
A + B + C
Code
Features
A + B + C
Design
Features
A + B + C
Plan
Features
A + B + C
WaterfallWaterfallAgileAgile
Plan
Design
Code
Test
Working Product
Feature AFeature A
Plan
Design
Code
Test
Working Product
Feature BFeature B
Plan
Design
Code
Test
Working Product
Feature CFeature C
Many Months to see value
Incremental Value for Every 2-3 Weeks

19. Agile Release Planning with One Scrum Team
Sprint
D1
Sprint
D2
Sprint
D3.. Dn
Sprint
H1
Sprint
D1
Sprint
D2
Sprint
D3.. Dn
Sprint
H1
Sprint
D1
Sprint
D2
Sprint
D3..Dn
Sprint
H1
Customer Release 1.0 Customer Release 2.0 Customer Release 3.0
2 Features
(30 User Stories)
3 Features
(48 User Stories)
2 Features
(32 User Stories)
April
2017
Aug
2017
Nov
2017
P1 Planning D1 Development H1 Hardening / Compliance / Final Documentation Please see exceptions for having Hardening Sprint(s)

20. Agile Release Planning with Scrum of Scrums
Sprint
D1
Sprint
D2
Sprint
D3
Sprint
D4.. Dn
Sprint
H1
Sprint
D1
Sprint
D2
Sprint
D3
Sprint
D4.. Dn
Sprint
H1
Sprint
D1
Sprint
D2
Sprint
D3
Sprint
D4..Dn
Sprint
H1
Customer Release 1.0 Customer Release 2.0 Customer Release 3.0
2 Features
(30 User Stories)
3 Features
(48 User Stories)
2 Features
(32 User Stories)
April
2017
Aug
2017
Nov
2017
P1 Planning D1 Development H1 Integration / Hardening / Compliance / Final Documentation
Sprint
D1
Sprint
D2
Sprint
D3
Sprint
D4.. Dn
Sprint
H1
Sprint
D1
Sprint
D2
Sprint
D3
Sprint
D4.. Dn
Sprint
H1
Sprint
D1
Sprint
D2
Sprint
D3
Sprint
D4..Dn
Sprint
H1
Please see exceptions for having Hardening Sprint(s)

21. Why Hardening Sprint?
 Non-Functional Product Requirements: Final Integrated product
testing for Security, Performance, availability, etc. which could not be
done during normal sprints
 Operational Efficiency: Limiting use of skilled resources and
optimizing the cost of maintaining multiple environment / systems
 Logistics: Co-ordination with multiple teams (Up-stream / Down-
stream) for end to end testing
 Availability: Infrastructure and Functional System Dependencies
 Compliance: Any compliance documents / process / check-list before
release to customers

22. Agile Planning
 Include Non Functional Requirements (NFR) – Create user stories
and track backlog
 Healthcare Regulation / Security / Compliance activities – Track in the
form of user stories
 Plan Hardening Sprints – External dependencies, Integrated product
testing
 Plan for Shared Resources availability (Architecture, KPI capture and
Management reporting, External Vendors, etc.)
 Leverage Team Velocity, performance, and baseline metrics for future
planning

23. Cisco Confidential 23© 2013-2014 Cisco and/or its affiliates. All rights reserved.
Case Study
Health Information Technology Projects
Success & Failures

24. Goal: First six months: 7 million individuals
will sign-up for insurance & 500,000 in
October 2013 alone
Time: Only 22 months to develop the system
and Go Live Date Oct 1, 2013
Cost: Budget $93.7 Million. Actuals varied
from $170 to $600 millions
Resources: Over 55 contractors developed
the three major areas of HealthCare.gov (UI,
Backend Integration, Cloud Services)
Complexity: Multiple real-time external data
sources and systems dependencies
(Experian, IRS, systems of insurance
providers)
Challenges: Weak program management,
Late arriving project specs. Last minute
changes and not enough time to do integrated
testing
Source: http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-pulls-the-plug-on-its-11bn-it-system-2330906.html
Science or art: risk and project management in healthcare, British Journal of Healthcare Management 2012

25.  World’s largest Centralized
database for Electronic Patient
Records
 Abandoned by the Government in
2011 after nine years of and spent
billions of pounds
 Unable to demonstrate the benefits
and value after spending £2.7bn
 Weak leadership in the department
 Lack of early consultation and
collaboration with health
professionals
 Vendor issues, Changing
Requirements, Major project
deliverable with multiple
dependencies
Source: http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-pulls-the-plug-on-its-11bn-it-system-2330906.html
Science or art: risk and project management in healthcare, British Journal of Healthcare Management 2012

26.  1.8 Million members
 Five districts
 140 branches
 4,000 independent physicians
 300 hospital department heads
 250 diagnostic institutes
 600 private pharmacies and public
as well as private hospitals.
 600 salaried physicians
 Specialty clinics
 A chain of 50 pharmacies and a
private hospital network
 Centralized laboratory system, a
tele-radiology system, telemedicine
services
Source: Kaye, R., Kokia, E., Shalev, V., Idar, D., & Chinitz, D. (2010). Barriers and success factors in health information technology: A practitioner's perspective. Journal Of
Management & Marketing In Healthcare, 3(2),

27. Maccabi Health Services: Barriers
Source: Kaye, R., Kokia, E., Shalev, V., Idar, D., & Chinitz, D. (2010). Barriers and success factors in health information technology: A practitioner's
perspective. Journal Of Management & Marketing In Healthcare, 3(2),
Financial&BusinessFinancial&Business
 Absence evidence of the economic
impact, Lack of clarity regarding the
specific cost-benefit to each of the
stakeholders
 Absence of financial rewards for
improved clinical information
exchange
 The perception of IT as a cost center
rather than a strategic enabler
 Absence evidence of the economic
impact, Lack of clarity regarding the
specific cost-benefit to each of the
stakeholders
 Absence of financial rewards for
improved clinical information
exchange
 The perception of IT as a cost center
rather than a strategic enabler
StructuralStructural
 Function and Structure of the Healthcare
System
 Lack of standardisation and certification for
EHR and health IT systems
 Lack of system and data interoperability
 Function and Structure of the Healthcare
System
 Lack of standardisation and certification for
EHR and health IT systems
 Lack of system and data interoperability
Technical&
professional
Technical&
professional
 A lack of synchronization between the
system and clinical workflow
 Clinicians lack of training in biomedical
informatics
 Lack of a professional workforce capable of
leading the implementation
 lack of a strategic organizational process to
develop the commitment of all of the
stakeholders
 A lack of synchronization between the
system and clinical workflow
 Clinicians lack of training in biomedical
informatics
 Lack of a professional workforce capable of
leading the implementation
 lack of a strategic organizational process to
develop the commitment of all of the
stakeholders
CulturalCultural
 Doctor’s view of Health IT
 Organization Culture
 Doctor’s view of Health IT
 Organization Culture

28. Maccabi Health Services: Critical Success Factors
Source: Kaye, R., Kokia, E., Shalev, V., Idar, D., & Chinitz, D. (2010). Barriers and success factors in health information technology: A practitioner's
perspective. Journal Of Management & Marketing In Healthcare, 3(2),
Innovative
Leadership
Innovative
Leadership
 Vision and making the decision
 Clear commitment and involvement of leadership throughout the process
 Appointment of an authorized health system integrator
 Addressing tangible, practical needs
 Establishing an organizational process for implementation
 Monitoring achievement of objectives
 Vision and making the decision
 Clear commitment and involvement of leadership throughout the process
 Appointment of an authorized health system integrator
 Addressing tangible, practical needs
 Establishing an organizational process for implementation
 Monitoring achievement of objectives
Partnershipand
Collaboration
Partnershipand
Collaboration
 Establish a multidisciplinary working group
 Create a joint vision of the health IT system
 Financial incentives for clinicians
 Establishing an ongoing collaborative process
 Making sure that benefits for clinicians are clear and visible;
 Providing training and ongoing support to clinicians
 Establish a multidisciplinary working group
 Create a joint vision of the health IT system
 Financial incentives for clinicians
 Establishing an ongoing collaborative process
 Making sure that benefits for clinicians are clear and visible;
 Providing training and ongoing support to clinicians

29. Cisco Confidential 29© 2013-2014 Cisco and/or its affiliates. All rights reserved.
Critical Success Factors
Ruggles, W. S. (2012). Electronic health records (EHR) deployment projects: a three-year retrospective of the best and worst project management practices. Paper presented at PMI®
Global Congress 2012—North America, Vancouver, British Columbia, Canada. Newtown Square, PA: Project Management Institute.

30.  Identify Stakeholders
 Define roles & responsibilities
 Assess any conflicting and
overlapping priorities and
Interests
 Change project resistance to
project support
 Incentives / reward system
 Educating benefits, value
Source: Gleason Grady, T. (2015). Management Toolbox. Stakeholder Engagement Essential to Health Information Technology Project Success. Radiologic
Technology, 86(6), 682-683

31.  Standard medical taxonomy
 Compliance Standards
 Best Practices
 Development, Testing, QA
Standards
 Measurement Standards
 Knowledgebase
Source: Gleason Grady, T. (2015). Management Toolbox. Stakeholder Engagement Essential to Health Information Technology Project Success. Radiologic
Technology, 86(6), 682-683

32.  Boundary Spanning (Vertical,
Horizontal, Stakeholder, ,
Demographic, and Geographic)
Communication Plan
 Communication Strategy (Mode,
Frequency, Audience)
 What, When, and How to
communicate
 Internal vs External
Communication
 Local vs Global Communication
 In-Person vs Virtual
Communication
 Cross Functional Collaboration
 Standardized Communication &
Collaboration Tools
Source: Maeder, A. J., Martin-Sanchez, F. J., Garrety, K., Dalley, A., McLoughlin, I., Wilson, R., & Yu, P. (2012). Managing collaboration across boundaries in
health information technology projects. Studies In Health Technology & Informatics, 17858-63.

33.  Business Strategy and Alignment
 Inter Project Dependencies
 Strategic Importance
 Identify Business Champions
 IT Innovation
 Phased implementation with
incremental gains to build support
and consensus
 Positive relationships
Source: Ernst, C., & Chrobot-Mason, D. (2011). Boundary Spanning Leadership : Six Practices for Solving Problems, Driving Innovation, and
Transforming Organizations. New York: McGraw-Hill Professional

34. Systems:
 Understand Business Requirement
(Clinical and Administrative)
 Understand end-users’ needs
 End user involvement
Process:
 Complex, interconnected, and
interdependent
 Understand business processes changes
 Understand socio-technical synergies in
existing business processes
 Avoid radical redesign of working
practices
Outcomes:
 Clear & measurable business objectives
 Continuous evaluation of outcomes
 Business Value Realization
Sources:
Bernstein, M. L., McCreless, T., & Côté, M. J. (2007). Five Constants of Information Technology Adoption in Healthcare. Hospital Topics, 85(1), 17-25.

35.  Capture Retrospectives
 Identify Root-Cause Analysis
 Small and Incremental
Improvement
 Major Process and Structural
Changes if needed
 Create a knowledgebase
 Share Best-practices across
organization

36. Key Takeaways
Stakeholder Engagement
Communication & Collaboration
IT-Business-Clinical Partnership
Standards and Best Practices
Systems, Process, & Outcomes
Continuous Improvement

37. 1. https://www.ahrq.gov/
2. Gleason Grady, T. (2015). Management Toolbox. Stakeholder Engagement Essential to Health
Information Technology Project Success. Radiologic Technology, 86(6), 682-683
3. https://www.linkedin.com/pulse/integrated-clinical-analytics-model-improve-business-dass-pmp-
phd/?published=t
Additional References

38. Q & A
dassconnect@gmail.com
https://www.linkedin.com/in/kaalidass