Implementation of an EHR: Focus on VistA

1. Implementation of an EHR: Focus on VistA Claudine D. Beron, PMP January 7, 2006 Claudine D. Beron, PMP June 26, 2007

2. Agenda • Need for an EHR • Implementation Lessons Learned • VistA Implementations • Project Management & PMI Methodology • Project Life Cycle • Project Process Areas • Project Management for VistA • Use Case on VistA VistA Software Alliance Presentation

3. Need for an EHR • 10% to 15% of the nation's doctors outside of the military and the Department of Veterans Affairs are using EHRs • 33% of surveyed hospitals reported having PACS installed* • 10% of surveyed hospitals have CPOE systems installed* • 62% of US hospitals state that IT investment was a top priority • * 2004 HIMSS Analytics database of 4000 hospitals surveyed and Commonwealth Fund International Health Policy Survey (2003). VistA Software Alliance Presentation

4. Reasons to Implement an EHR • Enhance the quality of patient care • Decrease and avoid medical errors - could save at least 44,000 and as many as 98,000 lives in the U.S. per year1 • Increase the profitability of the practice or facility - could yield a net value of $77.8 billion per year once fully implemented throughout the U.S.2 • Reduce costs • Increase revenue • Improve the proper coding of patient encounters - defensible coding • Provide backup documentation for: • Insurance company claims inquiries • Malpractice allegations • Comply with HIPAA • Facilitate decision support, clinical trials, and medical research VistA Software Alliance Presentation

5. EHR Implementation Lessons Learned

6. Key to Implementation of an EHR EHR implementation entails more than installing electronic tools-it's an opportunity to transform the entire organization. To use technology to improve patient safety and care efficiency, examine the assumptions that underlie quality care and consider which elements to maintain or improve. VistA Software Alliance Presentation

7. Lessons Learned • Both vendors and providers have commented that a large number of implementation failures exist in the industry typically as a result of poor vendor support and training. These failures impact the adoption rate of IT in the healthcare arena including EHR adoption. • reluctance of some of the doctors in a practice to use the HER • insufficient support and training • Perceived no return on investment or improvements in quality of life • unrealistic expectations VistA Software Alliance Presentation

8. Sample Implementation Road Map VistA Software Alliance Presentation

9. VistA VISTA INFORMATION SYSTEM VISTA SOFTWARE PACKAGES VOLUNTARY SERVICE ACCOUNTS RECEIVABLE REHAB MEDICINE LIBRARY MEDICAL RECORDS NURSING TRACKING ADMISSION DISCHARGE TRANSFER VistA IMAGING INTEGRATED DATABASE RADIOLOGY PERSONS PATIENT FUNDS BLOOD BANK PROBLEM LIST PATIENTS DRUGS RPC BROKER SOCIAL WORK MAILMAN LABORATORY COMPUTERIZED PATIENT RECORD SYSTEM (CPRS) MENTAL HEALTH DEVICE TASK MANAGER KERNEL WARDS MANAGER DENTAL LAB RESULTS ENGINEERING USER MENU MANAGER SURGERY SECURITY VA FILEMAN ONCOLOGY HEALTH SUMMARY BAR CODE MEDICATION ADMINISTRATION PRESCRIPTIONS INVENTORY DIETETICS INPATIENT PHARMACY IMAGES MEDICINE TEXT INTEGRATION UTILITIES(TIU) WOMEN’S HEALTH OUTPATIENT PHARMACY MEDICAL CARE COST RECOVERY INTEGRATED FUNDS CONTROL ACCOUNTING & PROCUREMENT • Sites of Care • Clinics • Hospitals • Nursing Homes • Domiciliary • Home/Workplace SCHED-ULING CONSULTS / RESULT TRACKING AUTHORIZATION SUBSCRIPTION UTILITY (ASU) CLINICAL REMINDERS CLINICAL PATIENT RECORD VistA Software Alliance Presentation

10. VistA Implementation

11. VistA Implementations in the US Specific Examples include : National Deployments: 1. Department of Veterans Affairs, (VistA)1007 sites-CONUS/OCONUS 2. Department of Defense, (AHLTA) 105 sites CONUS/OCONUS 3. Indian Health Services, (RPMS) 600 sites Single or Multi-site Implementations: 1. California Department of Corrections 2. California, Oroville, Oroville Hospital 3. District of Columbia – Department of Health (Dimensions Intl.) 4. Hawaii - Clint Spencer Clinic 5. Hawaii - Physician Center at Mililani (island of Oahu, Hawaii) 6. Hawaii, University of Hawaii Department of Geriatric Medicine (John A. Burns School of Medicine) 7. Oregon, Center for Women and the Family 8..Oklahoma Department of Veterans Affairs -8 sites 9. Oklahoma, Midwest City, Midwest Nephrology Associates, 10. New Mexico, Albuquerque, Presbyterian Health Service, 11.Texas, Midland, Midland Memorial Hospital -9 sites 12. Washington, Tacoma -Western State Hospital 13. Washington , Tacoma, Child Study & Treatment Center 14. Washington, Spokane, Eastern State Hospital 15. West Virginia, Bureau for Behavior Health and Health Facilities of West Virginia's Department of Health and Human Resources (7 sites) 16.West Virginia, Community Health Network of West Virginia (Network) VistA Software Alliance Presentation

12. VistA Implementations Worldwide Specific Examples include : 1. American Samoa - Lyndon Baines Johnson Tropical Medical Center (LBJ TMC) 2. Colombia, Bogata, Government hospitals 3. Czech Republic , XORS Inc. 4. Egypt, Cairo, National Cancer Institute 5. Finland, Helsinski, Helsinki University Hospital 6. Finland, University Hospital of Kuopio, 7. Germany, University of Wurzburg, Germany 8. Germany, Berlin, German Heart Institute 9. Kenya, Nairobi, World Health Organization's Collaborating Center on AIDS and Sexually Transmitted Diseases, University of Nairobi School of Medicine 10. Mexico - Instituto Mexicano del Seguro Social (12 hospitals) 11. Uganda, Kampala, Nakasero Blood Bank 12. Nigeria, Obafemi Awolowo University Teaching Hospitals 13. Pakistan, SKM Cancer Hospital and Research Centre VistA Software Alliance Presentation

13. Project Management &PMI Methodology

14. PMI Methodology • Project Management is not a cookie cutter skill set. Many project managers come from technical, clinical or other areas of expertise and are asked to manage projects for their organization without adequate training or skill development. The Project ManagementInstitute (PMI) has developed a methodology and tools that are widely accepted throughout the world to help manage projects are all levels (500K to 100M) and industries (Construction to Health care).As every Project/Program Managers is unique, every project is, especially in health care. • Tell me about the projects you’ve managed projects previously? VistA Software Alliance Presentation

15. PMI Methodology Project Management is accomplished through the use of the core areas including: initiating, planning, executing, controlling, and closing and represents over 44 processes. Each is interdependent to the other and iterative in the project life cycle. The PM process covers all phases within the life cycle of any project. A standard project will typically have the following phases: It is important to note that many of the processes within project management are iterative in nature. This is in part due to the existence of and the necessity for progressive elaboration in a project throughout the project life cycle Plan • Method/Approach • Schedule • Dependences • Resources • Cost • Project Charter Initiate • Sponsor • Requirements • Funding • SOW • Contract Execute • Deliver • Manage Control • Cost • Schedule • Resources Close • Cost • Schedule • Resources VistA Software Alliance Presentation

16. Scope Initiating Process Group Scope Develop Preliminary Scope Statement Develop Charter Initiate Phase Initiate Phase • This phase marks the beginning of the project or phase and formally authorizes the project. For a successful project, the objectives and requirements should be well defined at the start of the project. Initiating Process Group Processes A Guide to the Project Management Body of Knowledge – 3rd edition, PMI organization. VistA Software Alliance Presentation

17. Plan Phase Plan Phase • The Planning Process Group is considered the most important Process Group in project management. Time spent up front identifying the proper needs and structure for organizing and managing a project saves countless hours of confusion and rework during the Executing and Monitoring and Controlling Process Groups. • Project planning defines project activities that will be performed, the products that will be produced, and describes how these activities will be accomplished and managed. Project planning defines each major task, estimates the time, resources and cost required, and provides a framework for management review and control. • Planning involves identifying and documenting scope, tasks, schedules, cost, risk, quality, and staffing needs. This planning process: • Identifies specific work to be performed and the goals that define the project • Provides documented estimates regarding schedule, resources and cost for planning, tracking, and controlling the project • Obtains organizational commitments that are planned, documented, and agreed upon • Continues the development and documentation of project alternatives, assumptions, and constraints • Establishes a baseline of the plan from which the project will be managed. VistA Software Alliance Presentation

18. Planning Process Group Activities Sequence Work Activities Define Work Activities Develop Project Organization Schedule Activities Define Scope Statement (Project Objectives, Product, Deliverables) Develop WBS (Scope Definition) Identify Work Activity Resources Estimate Work Activity Durations Obtain Project Team Staffing Project Mgmt Plan Estimate Cost of Activities (Resource & Risk) Identify and Analyze Risk Events Establish Activity Based Budget Develop Risk Plans Management Plans (How the project will be managed during it’s executing, monitoring and controlling process groups) Develop Integrated Change Control Process & Management Plan Develop Communications Plan Develop Human Resource Management Plan Develop Procurement Management Plan Develop Schedule Management Plan Develop Scope Management Plan Develop Quality Management Plan Develop Risk Management Plan Develop Cost Management Plan Plan Phase Planning Process Group Activities A Guide to the Project Management Body of Knowledge – 3rd edition, PMI organization. VistA Software Alliance Presentation

19. Execute Phase Execute Phase • The Project Team and all necessary resources should be in place and ready to perform project activities. The Project Management Plan is completed and baselined by this time as well. The Project Team’s and specifically the Project Manager’s focus now shifts from planning the project efforts to participating in, observing, and analyzing the work being done. • The Executing is where the work activities of the Project Management Plan are executed, resulting in the completion of the project deliverables and achievement of the project objectives. This Process Group brings together all of the project management disciplines, resulting in a product or service that will meet the project deliverable requirements and the customers need. In this Process Group, elements completed in the Planning Process Group are implemented, time is expended, and money is spent. • This Process Group requires the Project Manager and Project Team to: • Conduct, coordinate and manage the ongoing work activities • Perform quality assurance activities continuously to ensure project objectives are being met or achieved • Monitor identified risks for triggering events and implement containment or contingency strategies as necessary • Distribute information to project stakeholders • Manage change. • In short, it means coordinating and managing the project resources while executing the Project Management Plan, performing the planned project activities, and ensuring they are completed efficiently. VistA Software Alliance Presentation

20. Communications Communications Information Distribution Team Development Integration Planning Process Group Controlling Process Group Project Management Plan Execution Quality Plan Contracting Procurement Source Selection Procurement Contract Administration Execute Phase Procurement Executing Process Group Processes A Guide to the Project Management Body of Knowledge – 3rd edition, PMI organization. VistA Software Alliance Presentation

21. Execute • During an EHR implementation, staff from nearly every department is affected. The project manager’s key role is to coordinate the different program units and develop the infrastructure required to plan for, carry out and monitor the EHR implementation. The project plan is vital as it details the timing and sequence of the implementation, as well as identify areas in which the workflow may require redesign. All project management activities are documented using standard templates and updated regularly. VistA Software Alliance Presentation

22. Execute – Change Management • The implementation of an EHR system creates significant organizational change. It is an intense process, because providers, nurses and staff are being asked to do their work in a new way. Often change engenders reactions, such as fear, resistance, even anger, so planned change management is essential to the success of the implementation project. Experience has shown that the most successful implementations demonstrate three key change management characteristics: top-down support for change; well-managed teams that share the implementation tasks; and support for new system end users by providing them additional time to learn the system while not being swamped with patient appointments. VistA Software Alliance Presentation

23. Control Phase Control Phase • Project performance must be monitored and measured regularly to identify variances from the project plan. Occasionally, current projects of the on-line era, also demand a change in an objective or a deliverable. Hence the methodology is equipped with a flexible yet well-defined process to control and manage the changes being requested to the project scope and objectives, and allows revisiting of the above phases anytime during the project life cycle. • Some of the main processes that can occur during this phase are: • Scope Change Control • Risk Monitoring and control • Cost control • Performance Reporting VistA Software Alliance Presentation

24. Integrated Change Control Scope Change Control Scope Verification Integration Procurement Scope Time Cost Scope Procurement Communications Risk Monitoring & Control Performance Reporting Schedule Control Cost Control Quality Control Planning Process Group Execution Process Group Closeout Process Group Control Phase Monitoring and Controlling Process Group Processes A Guide to the Project Management Body of Knowledge – 3rd edition, PMI organization. VistA Software Alliance Presentation

25. Communications Controlling Process Group Procurement Contract Closure Close Project Close Phase Close Phase • The last major Process Group of a project’s life cycle is the project Closing Process Group. Project closeout is performed after all defined project objectives have been met and the customer has formally accepted the project’s deliverables and end product or, in some instances, when a project has been cancelled or terminated early. Project closeout is fairly routine, but it is an important process. By properly completing the project closeout, organizations can benefit from lessons learned and information compiled at closure. Closing Process Group Processes VistA Software Alliance Presentation

26. Dynamic of a Project Organization Budget Limits Organization Commitment Stakeholder Management Change Management Budget Cycle Internal Politics Configuration Management Communication Management Manage a Project Obtaining the Right Skill Sets External Politics Control Initiate Plan Execute Close Subcontractor Management Quality Assurance Stages Knowledge Management Risk/Issue Management Expectation Setting Capturing Information Resource Management Solution Functionality VistA Software Alliance Presentation

27. Key Considerations • There are three key considerations that are most important to build a successful project: • Deliver to contract requirements – • setting expectations with the customer and ensuring that they understand what they will receive. A successful project is not one that delivers to customer requirements. • Manage within Schedule – • building a detailed enough work plan is essential to managing to milestones and schedule. • Manage within Budget – • keeping close control on hours by the team is crucial as well as other ODCs that must be paid for to complete contract requirements. VistA Software Alliance Presentation

28. VistA Implementation Methodology

29. PMI Project Life Cycle Project Management is accomplished through the use of the core areas including: initiating, planning, executing, controlling, and closing and represents over 44 processes. Each is interdependent to the other and iterative in the project life cycle. The PM process covers all phases within the life cycle of any project. A standard project will typically have the following phases: It is important to note that many of the processes within project management are iterative in nature. This is in part due to the existence of and the necessity for progressive elaboration in a project throughout the project life cycle Initiate • Sponsor • Requirements • Funding • SOW • Contract Plan • Method/Approach • Schedule • Dependences • Resources • Cost • Project Charter Execute • Deliver • Manage Control • Cost • Schedule • Resources Close • Cost • Schedule • Resources VistA Software Alliance Presentation

30. VistA Project Life Cycle Project Management for VistA is accomplished through the use of the core areas including: initiating, planning, executing, controlling, and closing and represents over 44 processes from PMI. Initiate Plan Close Execute/Control Assess • Environment • Needs • Standard Operating Procedures • Benefits • Resources Strain • Budget Accept • Identify Owners • Identify Stakeholders • Future Budgeting • Complexity Deploy • Hardware • Software • Configure to Environment Educate • Compare EHRs • Build Business Case • Develop ROI • Understand Functionality Train • Ongoing maintenance • Clinical Staff Support • Ongoing maintenance • Updates/Patches • Additional modules VistA Software Alliance Presentation

31. VISTA Implementation Methodology The interdependent architecture of VistA dictates a sequential implementation approach. Each project plan must first begin with the implementation of the PIMS to bring registration, bed control and scheduling on-line. Other departments such as laboratory, radiology and pharmacy may then be automated. Through this process a fully functioning CPRS with physician order entry may be achieved. PMI must be founded upon these requirements to maximize staffing efficiency. The systematic automation of hospital processes will also act to reduce the disruptive effects of large scale efforts. Foundation • Fileman • Kernel • Mailman Core • Lab • Radiology • Pharmacy Standard • CPRS • Dietetics • Social Work Extended • Imaging • BCMA VistA Software Alliance Presentation

32. Implementation Key Criteria • Executive Sponsorship • Involvement of key stake holders right from the beginning • Focus on Change Management not just technology • Well defined project plan with milestones and critical path • Accountability and process to make timely decisions • Risk mitigation – can’t eliminate risks; have to manage it • Defining the vendor performance and monitoring it • Assignment of requisite resources • Managing the expectation setting • Communication, communication, communication It is a marathon not a sprint VistA Software Alliance Presentation

33. Project Managementfor VistA

34. VistA Methodology Project Management for VistA is accomplished through the use of the core areas including: initiating, planning, executing, controlling, and closing and represents over 44 processes from PMI. Initiate Plan Close Execute/Control Assess • Environment • Needs • Standard Operating Procedures • Benefits • Resources Strain • Budget Accept • Identify Owners • Identify Stakeholders • Future Budgeting • Complexity Deploy • Hardware • Software • Configure to Environment Educate • Compare EHRs • Build Business Case • Develop ROI • Understand Functionality Train • Ongoing maintenance • Clinical Staff Support • Ongoing maintenance • Updates/Patches • Additional modules VistA Software Alliance Presentation

35. VistA Case Study • Holly Cross is a New York-based system that provides more than 1 million acute care visits each year through two major hospitals with over 500 inpatient beds and 38,210 annual discharges, and nine clinics. In the spring of 2006, senior administrators proposed implementation of electronic health records (EHR) to its medical staff. • The executive team viewed EHR usage as integral to the organization's strategic business plan, citing the need to support an infrastructure of care reorganization, refined quality measures and reporting processes, and evidence-based practice for management of chronic disease. Stakeholders would measure the implementation's success by how well EHR technology improved patient safety and care delivery, such as retrieval of patient information and clinical documentation throughout the health network. The system has planned a budget of $5 million per year for the next 3 years to implement an EHR and the first implementation must be completed in the next 6 months. Discuss what needs to be discussed and agreed upon for this to happen. VistA Software Alliance Presentation

36. VISTA Project Management Initiate • Educate Your Organization on VistA/EHR • Identify Owners & Stakeholders and get buy-in • Identify Subject Matter Experts in each area considered • Understand the Environment Today (high level only) • Description of organization by Bed#, Acute/LongTerm/etc and types of patients • Services provided today (note difference if more than one environment) • Legacy Systems in place? Which one’s • Interfaces (HL-7 ver 2.0?, NCPDP, etc) • Quality of Data, if any • # of Clinical and IT Staff Outside of the Project Team • Skills that will be needed • Develop Business Case that include preliminary scope requirements • Understand Budget Cycle and Politics • Understand Procurement Process (if vendors are used) VistA Software Alliance Presentation

37. VISTA Project Management Plan • On Site Assessment of the Environment's) • Detail questions/interviews for each clinical area to implemented VistA modules based on preliminary scope • Develop Gap analysis of actual systems and resources • Build Draft Project Plan/WBS & Schedule • Confirm Scope requirements • Prepare Budget and Resource needs assessment • Develop Request for Proposal (RFP) for Vendor Services, if applicable • Evaluate Proposals for winning bid with lead clinical staff included • Validate start date and terms and conditions • Select Vendor and approve start date • Update Schedule and Project Plan/WBS • Verify Staffing by Organization and Assignments • Verify Training by Organization and Assignment • Order Hardware/Software for Test/Development and Production Site(s) • Start up meeting to bring all stakeholders together VistA Software Alliance Presentation

38. VISTA Project Management Execute • Build Test/Development System • Include staff responsible for ongoing maintenance for training • Document System (Build Guide, Configuration Guide) • Test System prior to implementing VistA • Load VistA and Configure Modules mapped to current services • Foundation (Foundation, FileMan, HL7, Kernel, all mandatory) • Basic (Lab, Pharmacy, Scheduling, etc) • Standard (CPRS, Problem List, etc) • Extended (Hepatitis C, Medical Clinical Services, etc) • Include staff identified as subject matter experts to validate configuration of modules and training • Test System prior to ghosting to Production System • Provide 1st Round training while system is Test/Development • Verify configuration and usability by end users at Pilot Site • Deploy Pilot Site (Production Site) • Train SMEs and End-Users at Pilot Site • Evaluation of course material essential • Obtain Site Completion Sign off by owner • Deploy Disaster Recovery Site • Include staff responsible for ongoing maintenance • Deploy and Test at Additional Sites • Validate any differences in site by site services • Train SMEs and End-Users • Obtain Site Completion Sign off by owner • Implement and Support VistA Software Alliance Presentation

39. VISTA Project Management Control • Scope Change Control • Validate throughout the project that scope is aligned with deliverables • Changes documented in Change Request with owners signature • Risk Monitoring and Control • Develop Risk and Issue logs • Meet on weekly basis with team/owners to document and discuss mitigation strategies • Engage now owners if mitigation strategies aren’t working – don’t wait • Cost control • Review and document with team hours allotted and scope of work to be done • Manage weekly/bi-weekly/monthly timesheet reporting • Manage subcontractors, if any to their contracts • Manage weekly/bi-weekly/monthly timesheet reporting • Manage ODC’s and document any discrepancies in estimated vs actual cost • Report to owner when 75% of project is complete • Performance Reporting • Provide monthly reports on financials and milestone/deliverables completed based on schedule and project plan. VistA Software Alliance Presentation

40. VISTA Project Management Close • Complete closeout of any contracts subcontractors/product vendors • Document licensing and warrantee for systems • Sign off of customer acceptance • Attach site completion sign off’s • Closeout of any financial matters • Prepare final reports • Conducting a project review with all stakeholders • Documenting lessons learned • Completing, collecting and archiving project records • Celebrate! VistA Software Alliance Presentation

41. VISTA Implementation Matrix VistA Software Alliance Presentation

42. VISTA Implementation Matrix VistA Software Alliance Presentation

43. VISTA Implementation Matrix VistA Software Alliance Presentation

44. VistA Reading • Kalchugina, Townsend, “Medical Records in the Greater Los Angeles State Veterans Home: A Unique Opportunity to Improve Quality of Care http://repositories.cdlib.org/lewis/sr/student_report_02/ • West; O’Mahony, “Contrasting Community Building in Sponsored and Community Founded Open Source Projects,” Proceedings of the 38th Annual Hawai‘I, International Conference on System Sciences, Waikoloa, Hawaii, January 3-6, 2005. http://opensource.mit.edu/papers/westomahony.pdf • Goldstein, Ponkshe, Maduro, “Profile of Increasing Use of OSS in the Federal Government and Healthcare” http://www.medicalalliances.com/downloads/files/Open_Source_Software-Government_and_Healthcare_White_Paper-Medical_Alliances_2.doc • The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care , The American Journal of Managed Care, November, 2004. http://www1.va.gov/cprsdemo/docs/AJMCnovPrt2Perlin828to836.pdf • Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample , Annals of Internal Medicine, December, 2004. http://www1.va.gov/cprsdemo/docs/Internal_Medicine_Article_on_VistA.pdf • The Best Care Anywhere , Washington Monthly, January/February, 2005. http://www1.va.gov/cprsdemo/docs/Article_Washington_Monthly_Jan_Feb_2005.doc • Brown, Lincoln, Groen, Kolodner, “VistA – US Department of Veterans Affairs National Scale HIS,” International Journal of Medical Informatics. February 2003 http://www1.va.gov/cprsdemo/docs/VistA_Int_Jrnl_Article.pdf • Munnecke, Tom, “Personal Health: From Systems to Space,” July 19, 2002 • Hanson, Susan P. "HIM Role in Bringing e-HIM to Small Practices." Journal of AHIMA 76, no.4 (April 2005): 54-55,65. http://library.ahima.org/xpedio/groups/public/documents/ahima/pub_bok1_026428.html VistA Software Alliance Presentation

45. EHR Reading • Terry, Ken, “IT Implementation: Why EHRs falter ,” April 7, 2006 http://www.memag.com/memag/article/articleDetail.jsp?id=316528&&pageID=1 • IT Executives Offer Advice for Adopting Electronic Records MAY 21, 2007 http://emradvice.wordpress.com/tag/emr-failure/ • Planning, Early Support Keys to EMR Success, Execs Say, May 21, 2007 http://emradvice.wordpress.com/2007/05/21/planning-early-support-keys-to-emr-success-execs-say/ • Brief Report of the AAFP’s EHR Pilot Project: Key Learnings from Six Small Family Practices American Academy of Family Physicians Center for Health information Technology March 8, 2005 http://www.centerforhit.org/PreBuilt/chit_pilotresults.pdf • Kenneth G. Adler, How to Successfully Navigate Your EHR Implementation , February 2007 http://www.aafp.org/fpm/20070200/33howt.html • Laurie Craven, RN, So, you’re the project manager! http://www.doqit-tx.org/newsletter/DOQ-IT%2002_07.htm VistA Software Alliance Presentation

46. PM Reading • A Guide to the Project Management Body of Knowledge,(2000 edition) • Effective Project Management, Chapter 6. Wysocki / Beck Jr. / Crane. • The New Project Management, Chapters 8, 12-13, Frame, J. Davidson, 1994 • Earned Value Project Management, Second Edition, Chapter 5. Flemming and Koppleman • Project Management: A Managerial Approach, pp. 43-44. Meredith and Mantel • PMBOK (2000) Q&A, PMI, Scope Section • Ten Steps http://www.tenstep.com/ • AllPM http://www.allpm.com/ • C. William Ibbs, Young H. Kwak, “Calculating Project Management’s Return on Investment” http://www.ce.berkeley.edu/pmroi/calculating-PMROI.pdf • PMBoulevard http://www.pmboulevard.com/ VistA Software Alliance Presentation

47. VistA Links VistA-CPRS Demo - http://www1.va.gov/CPRSdemo/ CMS - VistA Office EHR – http://www.cms.hhs.gov/quality/pfqi.asp#Vista-Office%20EHR Indian Health - RPMS - http://www.ihs.gov/Cio/RPMS/index.cfm DoD - CHCShttp://www.tricare.osd.mil/peo/citpo/projects.htm Pacific Hui - http://www.pacifichui.org/ WorldVistA - http://www.worldvista.org Hardharts.org - http://www.hardhats.org/ Vista Software Alliance- http://www.vistasoftware.org VistA Software Alliance Presentation

48. Contacts Claudine Beron, PMP Accenture 703-947-3610 703-599-1203 cell claudine.d.beron@accenture.com VistA Software Alliance Presentation

49. VistA Software Alliance Presentation