EHR Adoption – Fix the Project Plan

HITECH was signed into law in February 2009 and the Meaningful Use clock starts in October 2011. We’re about half way through the process. How are we doing so far? Will we be ready in time? Everybody seems busy, none more so than ONC, and about $1.5 Billion has been awarded to States, Universities and Health Care organizations.

There are roughly five categories of grants: Interoperability, Adoption Assistance, Workforce Development, Pilots and HIT Research, all of them starting to take shape roughly at the same time. In parallel, ONC is working on the NHIN and NHIN-Direct interoperability frameworks, the EHR certification process is in final stages of definition, CMS is almost ready to finalize Meaningful Use criteria and NIST has finished a first draft of test procedures for whoever will be certifying EHRs during Stage 1 of Meaningful Use.

Arguably all the above are necessary endeavors towards the final goal of an EHR for every American by 2014. The only missing artifact is a Project Plan. A good old fashioned Project Plan with time-lines, milestones and above all dependencies of tasks on completion of other tasks. For example, EHR adoption assistance provided by Regional Extension Centers (REC) is dependent of the availability of a trained workforce, which in turn is dependent on the existence of training programs, which is dependent on the creation of a suitable curriculum. Not to mention that EHR vendors will also need to tap into properly trained cadres of implementers and trainers if they are to satisfy the astronomic increase in demand of their products.

While every single REC out there is issuing RFIs and RFPs for their short list of supported EHR products, the main requirement that an EHR be certified is dependent on a final definition of the certification process and on the accreditation of certification bodies, whose activities are dependent on a final version of NIST’s testing procedures, which is dependent on the definitive ruling on Stage 1 Meaningful Use criteria.

Anyone dealing with Project Management in daily life knows all too well what happens when you ignore dependencies. You miss your deadline. By a mile. And you go over budget. By a lot. And many times, the entire Project will be canceled as a result.

We, as a nation, cannot afford to cancel the HITECH Project. In a recent article, David Kibbe and Vince Kuraitis called for a Plan B. I’m an optimist. I still think that Plan A can be salvaged. However, it is imperative right now to reassess our time-lines and our milestones in view of the real status of each task, and its dependencies on all other tasks currently, and erroneously, proceeding in parallel.