Technology and project management are not the biggest challenges in mega IT deployments, according to a veteran IT project director with the Canadian armed forces.
“It’s the people problems that outweigh any other challenges you may have,” says Lt. Col. Jim Kirkland, a senior staff officer for Health Services Informatics. “The rest is just mechanics.”
Kirkland speaks from experience.
He heads up the Canadian Forces Health Information System (CFHIS) project – one of the largest and most comprehensive e-Health records programs in Canada.
CFHIS is designed to enhance everyday delivery of healthcare to this country’s armed forces.
Implemented in three phases at a total cost of Can $115 million, the project will enable more than 2,500 healthcare professionals located in 80 clinics across Canada to secure information and coordinate the care of 85,000 regular and reserve force member. The project’s first phase has just been successfully completed.
“You need a heck of a lot of people to pull off something like this,” said Kirkland.
The nearly 100 people who helped get CFHIS off the ground included vendors, systems integrators, hardware/software providers, privacy and security consultants, and more. They came from different backgrounds, provided different products, and services, and contributed diverse skills and expertise to the project.
Lockheed Martin was the chief systems integrator, Ottawa-based Dinmar Consulting offered the IS expertise, Purkinje Inc. from Montreal provided the core EHR application, while Tampa, Fla.-based SCC Soft Computer Consultants contributed an ancillary suite of laboratory, radiology, and pharmacy systems, with partner Calculus Informatique of Montreal ensuring that they are all bilingual.
Other leading technology companies – Citrix, Compaq, IBM, Oracle and Entrust – were all involved in some way or other, in most cases providing enabling applications.
It was Kirkland’s job to ensure these diverse stakeholder communities worked well together and came up with a system that successfully delivered the goods.
And he did it.
In addition to the right people – planning, common standards, and receptiveness to user feedback – are other key pre-requisites for the success of mega IT projects, Kirkland says.
On the planning front, he said, his team spent two years mapping out an infrastructure management program for CFHIS. “That may seem a long time, but it paid off in spades.”
As part of that plan the CFHIS project management team identified business processes to be supported by the system, looked at high-level data requirements, interface standards, security and confidentiality requirements, and even did a project profile and risk assessment. “This is unique, because outside of government hardly anybody does risk assessments,” said Kirkland.
Likewise, he said a Privacy expert was brought in to do a separate privacy assessment.
Common standards are yet another vital requirement – especially when the stakes are so high and the stakeholders so diverse.
“The problem in NATO – where you have different countries working together – is getting disparate medical management systems to talk to each other,” said Kirkland. He said common standards are the antidote.
CFHIS, he said, complies with NATO standard requirements for reports, and is consistent with the reference architecture adopted by ISO.
The use of standards – along with seamless co-ordination between applications ensures vital information gets to the right people quickly and accurately.
“Given the fast-paced nature of NATO operations this is vital,” said Kirkland. “Previously, when someone was injured we used to write the details on his chest and send him on for treatment. Now physicians need to know the ‘where’ and ‘how’ and a lot of other information…and all of this has to be communicated rapidly.”
CFHIS has the technology in place to accomplish this.
A bunch of ancillary applications work through an interface engine to a core clinical application that allows clinical notes to be created in an electronic format. So things like order entry (electronically ordering medication or lab tests), and results reporting are a snap.
This rapid flow of critical information has contributed to the spectacular response to the CFHIS project.
“We did a survey of our physician and other healthcare provider partners we deliver services to,” said Kirkland. “Somebody jokingly threatened me with bodily harm if we take away the solution from their clinic.”
Acceptance from the user community is the biggest triumph of any e-health project. According to Kirkland, user acceptance hinges on certain capabilities being readily available – such as the ability to do electronic order entry, results reporting, and organization/presentation of data.
“In other words unless your solution is quick, accurate and does not impede the care process, the guys will walk away from it.”