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Case Study—Memorial Health System CPOE Implementation
Memorial Health System is an eight-hospital integrated health care system in the Midwestern United States. The health system has two downtown flagship tertiary care hospitals, each licensed for more than 700 beds, located in the two major metropolitan areas served by the system. The remaining six hospitals are community-based facilities, ranging in size from 200 to 400 beds. These hospitals are located in the suburban and rural areas served by Memorial Health System.
Four years ago, the system’s board of directors approved a multi-million-dollar initiative to install an enterprise-wide clinician ...view middle of the document...
During the discussion with the board, several of the members questioned the timeline. One noted, “It took you 2 years to set up e-mail, and everyone wanted e-mail. This will affect every clinician in every hospital. Do you really think you can do this in 18 months?”
In an effort to demonstrate results, Dryer and Roberts demanded results from the clinical and IT team formed for the project. By this time, a rushed requirements analysis had been completed, an RFP issued, a vendor selected, and a contract signed. The acquisition process took a little more than 6 months, leaving a year for the implementation.
In protest, a number of prominent physicians took their referral business to the other health system in the area that seized upon the controversy by promising that they would not use a CPOE. Shortly thereafter, the two leading champions for CPOE—Dryer and Roberts—left Memorial. The chief medical officer, Barbara Lu, who was a vocal opponent of the project, was appointed interim CEO.
Although Lu was an opponent of the project, many members of the board still supported it. In addition, none of the board members wanted to lose a substantial down payment to the vendor, so Lu was instructed to proceed with implementing the system. Lu appointed a close colleague, Dr. Melvin Sparks, to serve as the interim CIO of the system. Sparks was both a practicing radiologist and a degreed computer engineer, so Lu thought he would be an ideal CIO for the system. Sparks hired Sally Martin as the executive project manager overseeing the implementation.
After evaluating the progress made to date and preparing a detailed thousand-step project plan, Martin reported back to Sparks on the status of the project with an exceptionally detailed report. Several key points were noteworthy in her report. Because of the rushed requirements analysis, several key workflow and system integration issued were missed. Consequently, to complete the project in the remaining 12 months, the organization would have to do the following:
• Double the IT staff assigned to the project from 16 to 32 people.
• Purchase approximately $500,000 in integration software not already budgeted.
o Alternatively, the scope of the project could be reduced from an enterprise deployment to something less than that.
o Alternatively, the duration of the project could be doubled to 24 months, keeping the staff flat but not avoiding the $500,000 software cost.
Dr. Sparks did not respond well to the news, exhibiting a great deal of anger at Martin, who was not working for the health system when the project was scoped and budgeted. Sparks yelled at Martin and told her never to come back into his office with bad news again. Her job, Sparks screamed, was to “figure out how to turn bad news into good news or no news.” As she left Sparks’ office, Martin resolved never to convey bad news to Sparks again, no matter how serious the issue was.
Over the next 12 months, the...