Transcript Evaluating Clinical and Admin Technology - Max

EMS Management Today
Washington DC
June 28, 2003
Evaluating & Improving
Clinical and Administrative
Tools and Technology
William E. Ott, MS, Paramedic
CPCS Technologies www.cpcstech.com
What is the goal of technology in EMS?
To provide the best possible care for our patients?
To have the most flashy wiz-bang toys in which to
impress rival services and attract new
personnel?
To improve revenues and speed reimbursement?
Some combination of all of these?
Issues to Address
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What do we do
Rate of technology change
Data systems
Bio-medical equipment
Communications equipment
Project management and control
Return on Investment (roi)
Total Cost of Ownership (tco)
‘I can do it well’
‘I can do it cheap’
‘I can do it fast’
‘Pick any two’
Red Adair
The Waterfall of Technology
Learnable-Usable
Technology
Available
Technology
Don’t be the management that
you have always
complained about
Return on Investment and Total Cost
of Ownership
• Where will we find ROI and what is the
TCO of these constant upgrades?
• Do we need the latest, greatest widget?
• Who drives our move to upgrade,
especially medical equipment?
• Budgetary constraints
• Are you proactive or reactive?
Rate of Technology Change
• Medical equipment 3 to 5 years
• Desktop PC hardware 18 months to 3
years
• Servers 3 to 5 years
• Software 12 to 24 months
• Communications gear 5 to 8 years
Important?
“We believe that the greatest advances in
medicine over the next two decades will
result from the application of the tools
and principles of information science to
the problems of clinical medicine”.
The National Center for Emergency Medicine Informatics
http://www.ncemi.org/
Security
Renewed Emphasis
Data Systems
Hardware
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PC based
Notebooks
Pen-Based
Handheld
PocketPC
Palm-Based
Voice Operated
Focus?
Most business sectors spend 12-15%
of revenues on information technology*
Hospitals spend an estimated 2.5% of
revenues on information technology*
EMS spends _____?
* Source: Philadelphia inquirer
Much waste in IT expenditures
• By some estimates, only 30% of IT related
projects in the public sector are completed
and those that are usually have significant
changes in the plan during the project
• EMS isn’t technically savvy like other
public safety groups, especially law
enforcement
• Poor technical project management skills
and planning
Input
• User Assisted
– Optical Mark Reader
Input
(OMR)
– Optical Character Reader
(OCR)
– Keyboard
– Voice recognition
• Automatic data capture
– Medical devices
Control
Mechanism
Output
Transformation
Transformation
Data is:
• Aggregated
• Cleaned
• Validated
• Analyzed
Control
Mechanism
Input
Output
Transformation
Output
Control
Mechanism
• Reporting
– Ad hoc
– Exception reports
– Aggregate
• Publishing
– Web-based
Input
Output
Transformation
Control Mechanism
• Quality
improvement
• Education
• Administrative
policies
• Medical protocols
Control
Mechanism
Input
Output
Transformation
EMS Data System Success
• My research reveals that the happiest
providers and most successful data
projects were:
– Built internally from scratch with work and
knowledge from staff
or
– Contracted out and custom built to the
providers exact specifications
EMS Data System Success
• Providers using the ‘customizable’ off the shelf
EMS packages are seldom happy with their
system
• Frequently these projects fail or go through more
than one product
• Lack of customization and lack of ‘your’ key data
points are the biggest issues
• Support is frequently an issue of contention
• Usually would be cheaper in the end to have
specced out and built custom system
Medical Equipment
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Who sets the standard?
Does it impact patient outcome?
How does it fit into your data system?
How do you measure the cost/benefit of new
technology patient care equipment?
• Learn to read and evaluate technical
specifications
• Where is the research?
• Don’t be bluffed by sales reps
Communications Options
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Wired
VoIP
GSM, CDMA, TDMA, IDEN terrestrial
CDMA Satellite
Trunked Systems
– 800MHz
– 700MHz becoming available
• Wireless Data
– BSDN
– GPRS
– PacketStream
Role of Project Management
Constantly balancing customer expectations and achievement of
internal business objectives, while simultaneously
delivering within the triple constraint
Risk
Risk
Customer
Expectations
Business
Objectives
Methodology
Requirements
The Project
Responsibilities of the Project Manager
• A number of demands are critical to the
management of projects:
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Acquiring adequate resources
Acquiring and motivating personnel
Dealing with obstacles
Making project goal trade offs
Dealing with failure and the risk and fear of failure
Maintaining breadth of communication
Negotiation
Issues in project management
• Users
– Often not clearly identified
• Use environment
– System Concept and environment are not
well understood
• Requirements
– Not well-understood by either customer or
developer
Major Reasons for Project Failure
• Incomplete, ambiguous, inconsistent
specifications
• Poor (No) planning and/or estimating
• No clear assignment of authority and
responsibility
• Not enough -- or wrong -- user involvement
• Lack of adequate tools and techniques
• Dependence on external sources (vendors,
subcontractors)
• High staff turnover or inadequate training
Project Management
• Waterfall development
– Emphasis on early closure
on specification
– Planning and design are
“simplified”
– Product may not meet
“real” needs
– Schedule and resources
often problematic
• Rapid prototyping
– Continuing user
involvement -- changing or
evolving requirements
– Planning and design are
complicated
– Product usually meets
“real” needs
– Schedule and resources
often problematic
Two Project Methods
• Resource constrained
• Time constrained
• Problem: Finish
project ASAP given
max usage can be
only Y in any period
• Must finish project in
X days/weeks, find a
schedule that
minimizes the
resources needed
The Waterfall Model
• First formulated by Royce in the early 70’s
• Further developed by Boehm (Software
Engineering Economics)
• Based upon a series of discrete phases, with
clear phase termination events and limited
feedback between phases
• Dependent on a clear understanding of the initial
requirements for the system
Project Management Sub-goals
• On time
– On-target estimate of project schedule and effective
monitoring and tracking of project activities.
• Within budget
– On-target estimate of project budget and effective
monitoring and tracking of project costs.
• With a high degree of user commitment
– Effective client relations, including involving users,
documenting requirements, and managing change.
All 3 PM Sub-goals are critical ...
Within
budget
On-time
User
commitment
• Ultimately, the
success or failure
of a project is
determined by the
satisfaction of the
person(s) who
requested the
project!
Risk Management
• Explicitly incorporated
into the project plan
• Implemented via Work
Authorizing Agreements
• Permeate the project
cycle
• Address technical,
schedule and cost
factors
• Risk identification
• Probability and
seriousness
assessment
• Decision process trade-offs
• Preventive and
contingent actions
Software Vendors
• Remember that every software vendor has
the cure for your data problems
• When you sell hammers, everything looks
like a nail
• Be cautious and ask tough questions
when evaluating software
• Evaluate software on your hardware with
no software reps around
Hardware Issues
• Using existing hardware?
• Obtaining new hardware?
– Buy?
– Lease?
– Avoid bidding if possible..
– Commit at last minute to get most for the
money
Hardware Issues
• Don’t lowball on hardware
– 256MB to 512MB of RAM minimum
– 19 inch monitors (15 inch notebooks)
– DVD, and CD-RW on at least a few
• Slightly more cost up front will return an
extra year or more in savings in life of
equipment
• (as of July 2003)
Hardware Issues – Vendors
• Last minute purchasing of custom configured
computers works well from Dell or Gateway
• Longer lead time required for IBM, HP, etc..
• Order ‘no-tool’ systems, easy to work on
• Order same configurations, preloaded, saves
hours of work
Types of Contracts
Fixed-price contract Cost-reimbursement contract
• Price remains fixed unless • High risk for the customer
the customer and contractor • Low risk for the contractor
agree
• Appropriate for high risk projects
• Low risk for the customer
• Customer usually requires that the
• High risk for the contractor
contractor regularly compare
actual expenditures with the
• Is most appropriate for
proposed budget and reforecast
projects that are well
cost-at-completion
defined and entail little risk
Networking Issues
• Investigate xDSL, cable, wireless, point to point
wireless, and BoP for connectivity to remote
sites
• Satellite Communication
• Networking with 10/100Mbps gear..keep an eye
on 1000Mbps gear now rolling out
• Committed Information Rate (CIR) from
broadband vendors
Size of Agency
• Larger agencies have more flexibility in
project planning, resources, budgeting,
etc..
– Failure is not as painful and more readily
accepted
• Smaller agencies require more precise
project planning
– Failure is painful
Reporting Project Status
Keeping team updated routinely and
regularly improves project success
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PERT Charts (Network Charts)
Critical Path Modeling
Gantt Charts
Calendars
Resource Utilization Charts
Personnel Utilization Charts
Timeline for Project
• The parties to the project need to discuss
and develop the timeline, especially if
custom software is being developed
• Arbitrary milestone times don’t work, the
people that must perform a task should
establish the milestones in discussion with
the other parties.
Training Issues
• It is best to have system installed and
operational prior to training the workers
• Scheduling training early in project cycle isn’t a
good idea
• Give workers access rights at training
• ‘Big Bang’ or ‘Slow Roll’
• Operate concurrent old and new systems until
new system is verifiable
• Must create and maintain personnel buy-in
Issues in Project Management
• Design
– Insufficient system analysis and no way to
measure adequacy
• Inadequate customer visibility into the
development process
• No common vocabulary between customer
and developer
• Unrealistic schedule and budget
Issues in Project Management
• Supply of project personnel with appropriate
skills is insufficient to satisfy demand
• No management attention -- too much
management attention
• No tools or training for project management
• Too few or no appropriate tools and
resources for development team.
Techniques to Support Teamwork
• Don’t insist on your process or solution if
another would work
– Be flexible
– Don’t sweat the small stuff
– Evaluation - (1) How many things were
resolved differently than you thought that they
should be (2) How many times did you offer
solutions instead of asking for them
Techniques to Support Teamwork
• Facilitate communication
– Provide tools (email, white boards, etc.)
– Have an open door policy and mean it
– Evaluate the communication process
frequently “Have you talked to…”, “What did
Lou say about that”
– Watch team in meetings -- who is left out
– Ask how you are doing and listen to the
answer
Consensus Decision Making
• Use it whenever you can
• Don’t fail to use it if….
– You don’t believe that sufficient knowledge
resides in a single individual
– You don’t have sufficient facts
– You need group commitment for
implementation
Project Management Tools
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Microsoft Project
Microsoft Excel
Risk Radar
Website
Conference Calls
Video Conferencing..easy, cheap now
Meetings
– Have only as needed
– Have set agenda and maximum time
Simple Project Tracking with Excel
Risk Radar Risks Display
‘I can do it well’
‘I can do it cheap’
‘I can do it fast’
‘Pick any two’
Red Adair
What is the goal of technology in EMS?
To provide the best possible care for our patients?
To have the most flashy wiz-bang toys in which to
impress rival services and attract new
personnel?
To improve revenues and speed reimbursement?
Some combination of all of these?