Consider the following scenario:
You are the health care administrator for a physician practice with five primary care physicians. Your practice has an existing electronic health record (EHR) system, which has been in place for three years. The EHR system has some existing functionalities to support the reporting of quality measures to Medicare to comply with public reporting requirements. However, there are some new requirements that require your practice to upgrade the EHR system’s software. To meet Medicare deadlines, this project will need to be completed within the next 12 months within a budget of $20,000.
Electronic health record (EHR) is a system which keeps track record of all historical data and information regarding patient’s health stored in electronic format (AmericanMedicalAssociation, 2017). This system is capable of storing complex data like HIV, prescriptions, radiological results, statistics, billing information etc. with an additional facility of transferring or sharing the data with other such system.
Being a health care administrator, after having a meeting with concerned physicians and owner of hospital has decided to upgrade the software for getting more facilities in storing and analyzing data. Project is sanctioned with USD 20,000 budget and required to be completed within 12 months, so start date of project is May 1, 2017 and finish date is April 30, 2018. In this document we shall discuss more about the planning tools like WBS, Gantt chart and Budget files.
Work breakdown structure (WBS) is the preliminary document prepared after the project is defined (Ibimapublishing, 2008). It is developed to capture the whole scope of requirement. It reduces the complexity of sequence in the activities and defines them as a collection. All tasks below any WBS must be measurable.
Accordingly all the activities or scope involved to upgrade software in Electronic health record (EHR) is also divided up to level 4. Just below the overall project “Software up gradation of existing EHR system)” is divided phase wise that is Engineering, Procurement, Construction and Commissioning. Because of the software up gradation project, in place of engineering it’s written as “Design” where all necessary engineering activities shall be captured like doing the route survey of cable, compatibility check, detailed scope checking, etc. before starting the detailed engineering. After gathering all such information, detail engineering of the system shall start and after finalization of around 60-70%, Bill of Quantity (BOQ) shall be generated. In next phase of project, by using BOQ, detailed procurement activity can be initiated. For each type of items separate ordering to be done wherever the vendors or suppliers are different, otherwise combined ordering can be done. Two major steps involved in procurement are “Ordering” and “Manufacturing & Delivery” in which ordering are normally done from office in Hospital itself by health care administrator or nominated project manager. Whereas manufacturing and delivery are done from vendor’s shop, so these two items are differentiated in WBS structure. Then the manufacturing can further be sub divided as offshore or onshore, that is out of country or in country respectively the manufacturing taking place. But in this case since the numbers of items are less than general industrial projects, so all items can be bought from same country. After procurement is done, now we need to execute the job at site by fixing all the items received to yield desired result. So after procurement next items noted is “Job at existing EHR machine” which means the physical work on old machine by removing all necessary data, remove all un wanted items from machine and then again reloading the new software and hardware required to upgrade the system. Since the new existing hardware unloading and loading of new hardware cannot be possible without shutting down the machine, so the WBS “Job at existing EHR machine” is further divided into “Pre-Shutdown”, “Shutdown” and “Post-Shutdown”. For going one level further that is level 4, the shutdown can be divided in “Existing” & “New” systems. Under existing and new WBS, the field activities like replacing the old hardware with new can be mentioned and even the loading the new software & data after the shutdown is over. Once all necessary engineering, procurement, installation is over, then comes the testing phase in which the physicians and medical administrators need to come forward and check the correctness of all data and may need to do some simulation checks and dummy running of machine to check overall performance and the machine become ready for use. Please see the WBS drawn as per above discussion. This WBS format shall also be reflected in Gantt chart format prepared using Microsoft excel software.
Figure 1. (WBS for up gradation of software)
Figure 2. (Gantt chart of software up gradation)
Figure 3. (Budget liquidation/ cash flow)
From the above Gantt chart, the budget file distribution is prepared. The budget is distributed in monthly format according to the activity duration and sequencing in Gantt chart. Once the cash flow schedule is prepared, the S-curve of schedule percentage distribution is plotted in graph. Now, in case of progress measurement we shall use the renowned earned value analysis method. In this method, say after 4 months of time (Sep 1, 2017) I need to present the project progress and forecast to owner. If the planned value in schedule s-curve is say 33%, it is presented as PV=33. And the actual progress achieved up to Aug 31, 2017 is say 30%, it is written as earned value, that is the work earned after putting effort, EV=30%. Then remains the other variable that is actual cost or expenditure done in project is written as AC. Say we already had expenditure of $8,000.
Schedule variance (SV) = EV – PV = 30 – 33 = -3% (-ve indicate delay)
Cost Variance (CV) = EV – AC = 30 – [(8000/20000)*100] = -10% (-ve indicate
So, we can say, that Schedule is 3% of 12 month = 0.36 month = 0.36 x 30 = 11
Similarly, cost is 10% of $20,000 = $2,000 overrun
This means, to complete the project at same pace and rate of expenditure shall need 11 more days and $ 2,000 extra to complete the project.
AmericanMedicalAssociation. (2017). Electronic health record (EHR) implementation.
Retrieved April 22, 2017, from https://www.stepsforward.org/modules/ehr-implementation
Ibimapublishing. (2008). A Work Breakdown Structure for Implementing and Costing an ERP
Project. Retrieved April 22, 2017, from http://ibimapublishing.com/articles/CIBIMA/2008/816423/816423.pdf
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