Implementing New Clinical Information Systems
A rigorous risk-management methodology now available
November 30, 2009
The information technology (IT) budget at Quebec’s healthcare institutions is growing every year. In 2007, it already stood at $2.7 million, not including the major projects funded by the Department of Health and Social Services (MSSS) and Canada Health Infoway. Yet despite the increasing amounts invested in this field, it remains difficult, in practice, to successfully implement IT projects and derive the expected benefits. The SIDOCI integrated clinical information system project, back in the 1990s, is a good example – it has been described as the worst technological failure ever in Quebec. The DSQ (Quebec health record) project is also receiving extensive coverage of late, in that significant time and cost overruns are expected.
To help IT project managers in the healthcare field, a rigorous methodology for assessing the risk applying to all clinical information system (CIS)* implementation projects has now been developed. Professor Guy Paré , holder of the Canada Research Chair in Information Technology in Health Care, and Claude Sicotte, Full Professor with the Department of Health Administration, part of the Université de Montréal Faculty of Medicine, have been collaborating closely since 2004 to design and implement this methodology. Three other people have joined the team along the way: Mirou Jaana, a postdoctoral student at HEC Montréal from 2005 to 2007, and now an Assistant Professor at the University of Ottawa, David Girouard, with an MSc from HEC Montréal, now a consultant with Deloitte, and, more recently, Placide Poba-Nzaou, a postdoctoral researcher with the Chair directed by Professor Paré.
Reducing the main risk factors
The key element in the new methodology is a grid of 23 risk factors associated with CIS implementation, broken down into seven categories. A Delphi study involving 21 healthcare experts from several Quebec regions allowed the researchers to build the grid and come up with a definition, validated and agreed upon by the experts, of each of the factors used.
The grid is used to determine the main risks that could interfere with the implementation of an IT project in a health institution. It is complemented by various tools for measuring each of the risk factors as objectively as possible. Essentially, these tools are:
- A questionnaire for assessing the organizational willingness required on the part of the players involved (doctors, nurses, etc.), both in the initial project phase and at the launch meeting. This tool is adapted to each project, and indicates the initial risk, based on these players’ perceptions. It provides valuable information on the conditions necessary for success.
- Interview grids adapted to the various categories of players: project managers, clinical experts, user representatives, project team members, hierarchical superiors.
- A questionnaire for assessing the risk associated with the project, to be completed by all project team members, sometimes more than once. This tool, currently being validated, makes it possible to track the risk level over time and to identify differences in perception on the part of the project team members.
The offer of service includes support for the project team, by sitting in on meetings or user training sessions. Lastly, the assessment makes it possible to suggest risk mitigation measures to the project team or other parties, such as the computer application supplier. Such recommendations will be backed up with justifications, and the suggested actions will also be prioritized.
Transferring knowledge and fine tuning the methodology
The result of many years of work by the research team is now available to Quebec healthcare institutions, thanks to a licensing agreement for the methodology recently signed with Ovila Girard Groupe Conseil (OGGC), a consulting firm extensively involved in the health sector.
Before their methodology was brought to market, however, the researchers applied it to different projects at various healthcare institutions. They then spent a year helping OGGC at each step in a vast IT project for home care, at nine sites in Quebec.
While the knowledge transfer is now completed, the job is not yet done. The researchers are continuing their work to fine tune the methodology. Among other improvements, they hope to adapt it to the European and United States markets, beginning by conducting Delphi studies there. They also plan to create, probably through a partnership arrangement, a secure online tool to simplify the administration of questionnaires and the handling of the data collected.
* E.g.: implementation of an electronic patient record, various telehealth applications, and information systems to support radiology, home care, laboratories, pharmacies, etc.