AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
MICHAEL WEBB: I’m delighted to be here with you. It gives me a chance to get my foot much deeper into the business side of what I do each day and that is work with IT systems that support the Child Health Programs and then further to associate with those of you who not only establish but administer and mature these programs. It’s a good privilege for me. My topic as mentioned is Establishing and Maintaining Partnerships. This is really an important aspect of a topic that is larger, that of integrating health care data and it’s so vital in being able to do that at any level that I think this is a good place to start with this session. I want to make sure you have a good reference for my remarks so the approach I’ll take to this particular presentation is I want to talk a little bit about what a partnership, at least in my mind, is and then the examples that I use, the tools that I’ll describe in maintaining and I’d like to rather than maintain, use the word Nurture Partnerships, are derived from the program that we have in Utah called the Child Health Advanced Records Management Program. And it’s an integrated system I’ll talk to you a little bit about.
And then finally, I come to this presentation from a Project Management perspective and I’ll talk a little bit about that. As I talk about the tools that we use and that have come to bear in our project, in our program, I’ll do that from the various phases that are in a typical project. Let me go back. I’ve gotten ahead of myself a little bit here. There is a real distinction in my mind between the term stakeholder and partnership. One is passive, can be passive and the other is active. We see on the first bullet point there that a stakeholder is anybody that has an interest or a share in a project or an effort. But if you look at the partnership aspect of it, it’s really a stakeholder that has a relationship with that program or project management that is characterized by mutual cooperation and responsibility. They have a definite role to play. And so the job that a person in my role as a manager has is that I have to pay attention to the expectations of all stakeholders, but I have to take extra care when it comes to those partnerships that move an effort along and I use the term again here, you have to nurture those things and I’ll show you some tools hopefully that will be useful in doing that.
Now the project or program that I work with mainly and there’s several others, but the one I do mainly is what we call the Child Health Advanced Record Management Program of CHARM in Utah . We come at integrating data a little bit different than others that have chosen to do that. A couple of ways of integrating data, one is to kind of gobble up all the systems involved with data integration or that the information is going to be put in one spot. Tearing those systems down, building a separate system with a separate central database. We take a different approach in Utah and we’ve done it for several reasons among cost, effort, allowing programs to mature and grow on their own, are just some of the reasons why we took this other approach. But showing up in this area and you can’t probably read all of this from where you’re sitting, and hopefully your handouts will help a little bit. But in this area here we show the Utah Department of Health Programs that are involved in the integration effort, at least the first five.
We show over here our immunizations, our early hearing and detection, early intervention, vital statistics, and newborn screening, the blood spot. And with a little area out here that indicates that that will expand as we, as we mature the system. This area down here shows what we’ve really done technically to cause this integration to happen. We have chosen to build a software middleware or integration infrastructure to do that. And there’s two basic components. We have an agent component and a server component. This is the, kind of the traffic cop element of the technical system that allows all of these internal systems here to communicate between one another. And then the server component out here, you see a core data structure over here. Only thing that’s in this core data is enough information to do matching, matching of individuals between the various programs. We also do a little bit of cataloging, of services, and queries, we do some other things in that database. So this is the integrate, this is the infrastructure that technically allows our integration to happen.
We are implemented in with the first three programs, immunization, the early hearing detection, and our vital statistics. Early intervention and newborn screening are in our next phase, which will be in the next six months. We’re actually building a new system for our early intervention providers that will have the CHARM integration piece already built into it. It’s another one of the efforts that I’m involved with. But other key things is here on, this block over here represents the outside of Department of Health. We show one element in there that’s already integrated into that and that’s the workstations that are in our Intermountain Healthcare Hospitals in Utah . There’s about 18 of those, I believe. They for example, already have an integration into our immunization program. They can, through, on their work screen, they can actually press a button and through a web connection, connect right to the immunization system and get immunization status. So they’re already integrated. We’re just going to bring them further into the system. And then down on this corner we show just another external partner.
Down the road we intend, when we get mature enough, the data is clean enough, that we’ll actually feed the warehouse, data warehouse at the state of Utah . Shown here are the typical process groups or phases in Project Management. They flow basically end-to-end, except when you get down on this area of executing and control. There’s interaction there and then closing is the last part of a project. Make sure you understand this is closing of just a project, not closing of a system. The Project Management process sits on top of a life cycle of a system, and this is only for the closing of the project. But the point here is that partnerships with our particular effort have been established and nurtured through all of these phases and are on going. We haven’t got here yet but through all of the on going phases. And then when we talk about the tools, I’ll talk about them in terms of what we’ve done in this phase, in this phase, et cetera.
The actual establishment of partnerships comes in many ways. It’s clear in our effort and I think if you’re involved in these kinds of efforts you’ll be in the same boat. You have external and internal partners. And they’re established through various, a variety of ways. The focus groups, I notice they show up on both. We’ve had focus groups involved that can be classified as internal as well as external partners. The program charter, which basically is what gives formality to a project or a program, defines the mission, the vision, the roles, et cetera. Interdepartmental agreements. This particular element has been vital to us because the way we facilitate sharing between programs in the state of Utah is we enter in formal data sharing agreements. And those agreements specify what can be shared with other programs and what’s needed to be shared. On the external side, funding grants, this is a big player for us.
Our program is basically funded by grants. We have no, other than in kind resource contribution, people taking time out of their daily routines and their basic jobs to do this, there is no state money behind our effort. Again, focus groups, we have significant contract work for the technical development and memorandums of understanding both formal and informal. Just an example, I couldn’t list them all because there are quite, quite a number. But the main internal partners for our effort include the executive management team, participating programs, our grant managers, our principal investigators, work thread chairman and I’ll explain that one in a little bit. And then two kind of governing bodies that are partnerships in what we do. Our executive management team is basically, their role is one of vision and sponsorship and it includes our executive director at the Health Department, our CIO at the Health Department, and Division Director. And then the participating program teams are those individual program managers, those who manage immunizations, early hearing and detection, vital statistics, et cetera.
Their technical leads, and most of them have other staff members, actual users involved in their teams. The Grant Managers, of course, that’s more obvious than the other two and they participate and I’ll show you in just a minute where some of these participate. It was clear to us right from the beginning as we embarked on this CHARM Program that it was more than a technical effort and that there were other work streams involved. So we wanted to make sure if we were going to succeed in what we were doing that we couldn’t just have a technical approach to this. We had to address the other kinds of things that needed to get done and work threads evolved into seven basic different work threads that included of course, a technical work. The technical work done by the programs themselves and there’s a little bit, even though we preserve their systems in this approach, there’s still some work that they needed to do.
We have a work thread or a work stream that includes organizational change. One that included communication and marketing, and that by the way is a big one when it comes to nurturing partnerships, one that pays attention to data quality. Again, our approach to integration requires that those systems that are going to share information, that there data be as clean as possible. Otherwise you’re going to run into trouble with matching and those kinds of issues and reliability of information. And then our governing board is an organization defined to manage the grant process, the use of the grant money. And then finally the CHARM Core Council is another executive kind of level group that deals with the content and the extent of integration. The participating programs, executive management team, word thread chairman, are involved in these two working kinds of organizations.
External partners, they include those listed. We had a pilot project here to get at the issue of data quality. What we did was we ended up establishing a record number, a birth record number that was perpetuated into the three of the main or the first programs to be integrated. And that was done when the cooperation of the hospitals involved, all of the birthing hospitals in Utah . And they voluntarily worked with our program staff and implemented this to where they have them use that number now in all of the hospitals relative to hearing, relative to vital statistics, and relevant to newborn blood screening. A very good correlation now of data as that data comes back into the state central program information, there’s a high correlation now between individuals because of perpetuation of this birth record number. We had a contractor that helped us with out needs assessment and then we have a large partnership with Utah State University working with grants and technical consulting programs, management assistance and the last bullet there, a key thing for our technical side is, they’re helping us do all of that technical work, the technical development. And finally, I just listed here again, you can see quite an impressive array of grant sources of funding for us and they’re on going.
I’ll sort to the meat of my message is here in that when it comes to maintaining or a better term, Nurturing Partnerships, that requires the application of what I call appropriate communication and marketing tools. Appropriate meaning that it’s targeted basically on the role of that partner, the availability of that partner, the location of that partner, et cetera. Going back to that first phase of a project, initiating phase two was our needs assessment. And Sherry is going to talk a little bit more about this. Our particular effort did all of those things listed here. Again, it involved focus groups. Focus groups included the Department of Health, Utah Department of Health Officials, family representatives, private provider representatives. And in the effort, we ended up with these kinds of things in that needs assessment.
Basically what it did was validate what that need in Utah was for integrating data and then recommended the next steps, which gave it momentum to move forward into the next phase. And that next phase was the planning, and again, the key tool there was what we call our data integration plan. I’ve been involved with technical programs for almost 20 years now and I stepped into this project, program, two and a half, almost three years after it got started. It was the best defined effort, up front defined effort that I’ve ever been involved with and so that I think has helped us move forward to where we can call it a success. But this plan served basically two things, two purposes. First was a program charter. In this integration plan it defined the mission, the vision again, defined the government structure for this program. It has the objective and goals of each of the work threads and it did define the work threads, by the way. And then from a planning standpoint it had, it included the activities in each of the work threads, the high level timeline, the activities, the deliverables, and even made recommendations, which is unusual at this point in time on how to evaluate or do measurement or measure the outcomes of these work threads. So it was a very well done complete document.
I brought this with me so if anybody wants to look at that and look it over you’re welcome to do. I have two copies I’ll be able to share and also point you to a website that you can go look at it as well. Moving to the execution phase, I’m showing here an example. We chose to do our, taking that high level information that was in the data integration plan, moving it to the next level of detail. We’ve used a scheduling tool, Microsoft Project, you probably are aware of it. But until you do something like this, you cannot understand how big the effort is, how large the scope is, and when it can get done. If you’re looking in just planning terms, you really don’t have but more than a vague idea of how long and what the effort is in doing this. So we chose to go this route. We created a master program plan and then we listed all of the work streams as sub programs or sub schedules. Again you can see, a sub project for communications and marketing data quality.
I think this is the data rules and policies, and organizational change and then the two technical efforts on the bottom. Now the way this came about was the program management, which I’m involved with, led this effort but when it came to doing these sub projects, those thread leaders, actually planned and did their own work. The other advantage of using this tool is that when you get the relationships of the tasks in there, in other words, the dependencies. And the dependencies can be within a project, a sub project, or they can be across all of these things. That’s what helps you determine how long things take. And then the assigned resources, we took the effort also to do what I call traceability. When you get to the end of a technical effort, you have to be able to do an acceptance process and that ties all the way back to the original requirements. And so here in the notes section of all of these tasks, we wrote a reference back to the data integration plan, the needs assessment.
Those paragraphs, that express a requirement, we can find those in this array of schedule tasks. Now, a primary tool that we use, also, again to nurture these partnerships, these key partnerships, was this status report we developed. And we do this for each work thread and we have done this on a monthly basis. This, the way this is structured, we do summary statement of that thread and then on this task matrix over here, the tasks that are listed here come right off that master or sub project schedule. And we pull those off sort of in a critical pathway those things that are most remain at that period of time. List them here. We list our status in a color code arrangement here, percent complete and their target date. So people looking at this have an immediate visual reference to where things are. If things fall in the issue or the yellow, or the red category, that requires an explanation on the current challenges and the corrective actions over here. That’s how we have done that.
I mentioned the website. We have two. We have one is for external use and one for internal. I’ll show you the external one here and I don’t know if you can read the URL but it’s charm.health.utah.gov. And this is more of a marketing tool for again, those who are on the more executive level and those programs that are yet to join or become participants in our integration effort. And I believe, I’m almost certain this website has this data integration plan on it. It would probably be under the projects link right here. Other executing phase tools, we realized again, very early, that to keep those partners engaged and informed we took the approach of doing system demonstrations. Almost at every turn, okay, I’m getting a sign here. Almost at every turn in the system development it did validate concepts, it validated architecture, it validated designs and the other kinds of things we’ve done here with our external partners. I don’t want to leave here without talking about our user group.
Again, we formed that group out of the core users of the system. They are becoming the primary trainers, the primary advocates, and the primary people that contribute to the user interface part of the technical system. In the controlling phase, our main tool is our change management plan. Our technical system baseline is defined by a requirements document, design documents, and interface documents. Any change to those baseline documents is processed through this description and this change management plan. And again, to keep interests up, it has to be a two way kinds of things, it’s a nurturing thing, so we have provided a way for any partner to write an issue, to express a recommend an enhancement, and then record that and then we take it and log it and process it. Two other tools, this issue log is mostly for technical issues. And then of course, the budget report that’s used both in the core council meeting and governing board.
And then finally, touch a little bit on the topic that Alan’s going to talk about and that is in our closing phase we’ll implement what we call our outcome measurement plan and that’s been developed through a user, again, a working group we call the CHARMO. It’s a road map to determine how the requirements that we started with, the goals and objectives are met and if they have been met. Again, a couple of other closing phase tools and then to take away from this presentation, the real foot stomper in military terms is that partnerships are vital. They have to be there or you won’t get to your goal line. They have a multiplier affect, in other words, you can do more with them than without them and then they’re not for the faint of heart. It takes a lot of work to nurture and to keep them going. Okay. That’s it.