HITECH-Meaningful Use and

The Benefits of the

PMI and ITIL Relationship

May 20, 2011

William ‘Buddy’ Gillespie, ITILv3 Certified

Vice President & Chief Technology Officer

WellSpan Health

The Journey

Meaningful Use

Introduction• Since the HITECH Act was passed in February,

2009, healthcare executives have felt the pressure to implement the electronic health record and achieve Meaningful Use status resulting in the flow of incentive dollars over the next five years.

• In the rush to purchase and implement EHR solutions, healthcare executives are finding that Project Management Standards (PMBOK) and best practices for IT Service Management (ITIL) need to blend together in order to establish a reliable roadmap to achieve and sustain the objectives of HITECH.

Objectives• Introduce the requirements of the HITECH-MU

objectives;

• Identify the challenges facing healthcare executives relative to the achievement of Meaningful Use;

• Share the commonalities between PMBOK and ITIL;

• What approach should be taken to blend the two practices into a seamless process & avoid gaps;

• What are the expected benefits;

• Share lessons learned and recommendations for success

Agenda

• HITECH & Meaningful Use

• Challenges

• PMBOK & ITIL

• Project Process vs. Operational Process

• Approach & Implementation

• Benefits

• Lessons Learned

• Recommendations

Myths

• Service Management plays no part in the

project planning process

• The only touch point between project

management and service management is

at the go-live hand-off to production

• The ITIL Release Management best

practice is the only guidance that ITIL

provides the project

HITECH-MU Objectives

• Adoption of certified EHRs

• Meaningful use of EHRs

• Incentive payments to eligible professionals and hospitals

• Investment in nationwide HIT infrastructure

• Grant money for demonstration projects

HITECH-MU Outcomes

• High quality, safe, effective, and equitable

care for all

• Seamless patient-centric care

• Realigned incentives and measures that

foster prevention, intervention,

coordination, effectiveness

• Regional clinical information

interoperability on a national backbone

Meaningful Use is a Journey

3-Stages over 5-Years

Challenges• Only 20% of Physician Practices have an

EHR

• Competing projects on the horizon– MU

– ICD-10

– HIPAA 5010

• Cost of IT Infrastructure

• Lack of Best Practices Use for PM & ITSM

• Current focus on implementing vs. sustaining technology

The Big Picture• Many IT organizations around the

world are turning to PMBOK® best practices to help them achieve improved capabilities in meeting the needs of their business.

• Another best practice frameworks that is sweeping the globe is ITIL® –Information Technology Infrastructure Library™.

PMI-PMBOK

• PMBOK

– “Project Management Body of Knowledge”

– Universal Standard for PM in US and the

Globe

– Foundation for PMP Certification

– PMBOK® Guide1 4th Edition

ITIL V3

• ITIL

– “IT Infrastructure Library”

– UK Office of Government Commerce

– Growing Popularity for ITSM

– ITIL®2 v3 as framework

Definitions• Project:

– PMBOK: “A project is a temporary endeavor undertaken to produce a unique product, service or result”

• Services:– ITIL: “Services are a means of delivering

value to customers by facilitating outcomes customers want to achieve without taking on the ownership of specific costs and risks.”

ITIL Best Practice

• What is ITIL?–The Information Technology

Infrastructure Library-V3.0

–Provides a systematic-best practice approach to the delivery of cost effective and quality IT services

Alerts, Exceptions & Changes

-Inquiries-Communication

-Reports and updates

-Availability plan

-Targets / thresholds

-Reports

-AMDB

System Management Tools

IT Infrastructure

-Capacity plan

-Targets / thresholds

-Reports

-CDB

-Financial plan

-Types & models

-Costs & charges

-Budget & forecasts

-IT continuity plan

-BIA & risk analysis

-Define requirements

-Disaster recovery contracts

-Security plans

-Intrusion prevention

-Security event logging

-SLAs, OLAs, SLRs, UCs

-Service catalog

-Requirements, targets, achievements

Source: W. CookUsed with permission.

Service LevelManagement

Availability Management

Capacity Management

IT Financial Management

IT Service Continuity

Management

Information Security

Management

Customers & Users

ITIL Service Level Management

Service Desk (Function)

Service Design & Support: The Operational Processes

Configuration Management CMDB-CI records & relationships -Entire IT infrastructure -CMDB reports & statistics -Audit reports

-Incidents -Problems -Known Errors -Changes -Releases

-Difficulties

-Questions

-Requests

-Workarounds

-Incident status and updates

-User communications

Incidents

-Service reports

-Incident statistics

-Audit reports

-Trend analysis

-Diagnostic aids

-Problem reports

-Problem statistics

-Problem reviews

-Audit reports

-Process Request for

Changes (RFCs)

-Forward schedule

of changes (FSC)

-CAB minutes

-Change statistics

-Change reviews

-Audit reports

-Release schedule

-DSL & DHS

-Test standards

-Release statistics

-Release reviews

-Audit reports

Customers & Users

Incidents

-RFCs from IT staff,

users, customersNew releases

RFC

RFC

Automated Tools

Source: W. CookUsed with Permission

Incident Management

Problem Management

Change Management

Release Management

Service Delivery• Four Main Components

–Service Catalog (Transition

Catalog during project cycle )

–Operational Level Agreements

(OLAs)

–Underpinning Contracts

–Service Level Agreements (SLAs)

–CI(s) & CMDB(s)

Service Catalog• Listing of services provided to

customer

• Can include varying degrees of

service (e.g. gold, platinum, bronze,

etc.)

• Many application catalog entries

encompass entire application

“platforms.”

Operational Level Agreements (OLAs)

• Agreements between

respective areas of the I.S.

department with each other

• Must be able to commit to

each other before committing

to customer.

• Needed to be able to build

SLAs with Customer

Approach

• Inclusion of ITIL Service

Management Activities in the Project

Life Cycle Tasks

• Identify stakeholders across the

continuum

• Establish OLAs between PMO and

Service Design & Support team

Integration of ITIL Activities

and PMBOK Tasks

• ITIL Activity

– Service Portfolio

– Financial Mgt

– Demand Mgt

• Project Plan Tasks

– Service Definition

– Budget

– Business Case

Integration of ITIL Activities

and PMBOK Tasks

• ITIL Activity

– Service Catalog Mgt

– Service Level Mgt

– Supplier Mgt

• Project Plan Tasks

– Service Definition

– Service Level Rqmts

– RFP & Select

Integration of ITIL Activities

and PMBOK Tasks

• ITIL Activity

– Availability Mgt

– Capacity Mgt

– Continuity Mgt

– Security Mgt

• Project Plan Tasks

– Impact, Risk & Plan

– Plan & Measure

– RPO & Plan

– Design & Validate

Integration of ITIL Activities

and PMBOK Tasks

• ITIL Activity

– Change Mgt

– Asset & Config Mgt

– Release Mgt

– Knowledge Mgt

• Project Plan Tasks

– CAB & RFC

– CI(s) to CMDB

– Version Control

– Documentation

Integration of ITIL Activities

and PMBOK Tasks

• ITIL Activity

– Event Mgt

– Incident Mgt

– Request

– Problem Mgt

– Access Mgt

• Project Plan Tasks

– Monitoring

– Categories/Escalation

– SR Forms/Procedure

– Work Around(s)

– Approval/Procedure

Impact of No Collaboration

• A project deliverable which is difficult

to support and sustain

• A solution which is a vertical

deliverable and difficult to “fit” into the

Service Catalog

• Lack of consensus of all stakeholders

Lessons Learned

• ITIL is a journey not a sprint

• Credibility is achieved in increments

not a big-bang

• The move from a project focus to a

holistic view of project plus service

management is not an over night

change

Benefits

• Increased opportunity to service and

sustain the EHR and MU deliverables

• Position organization to expand

foundational systems for the next big

wave of change: ACO, Medical Home, etc.

• Achieve consistent quality of project

deliverables beyond the project closure

Recommendations• PMO updates Project Work plan to include

ITIL Activities

• ITSM Core Team to engage with PMO

• Request PMs to become ITIL V3 Foundations Certified and engage with ITSM Leadership

• Establish Collaborative View of Project Success between PMBOK and ITIL

• Establish Milestone check-points to monitor PMBOK and ITIL Integration

Thank You