Q and A With Wayne Thompson

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University of Medicine & Denistry of New Jersey

The CIO of the nation’s largest health science university explains the phaseby-phase process of implementing a local health information infrastructure.

Healthcare Technology: Can you give us some background on UMDNJ?

Wayne Thompson: UMDNJ is the nation’s largest health sciences university.We are New Jersey’s statewide system of health sciences education, biomedical research and healthcare. Founded in 1970 to consolidate New Jersey’s health professions education, UMDNJ has become the very core of the state’s health sciences system. We have more than 4,000 students of medicine, dentistry, allied health, nursing and the life sciences, and more than 1,000 medical interns and residents. UMDNJ is the single entity responsible for statewide undergraduate and graduate medical and dental education, as well as for other health professions.

The university is New Jersey’s primary source of continuing and advanced education for health professionals. Through its eight schools on five campuses throughout the state, the university provides New Jersey with a supply of top-quality health sciences professionals appropriate to meet the current and future needs of its healthcare delivery system.

HCT: Can you give us some background on your local health information infrastructure initiative?

WT: The initiative really evolved a few years ago, when there was recognition that a number of pieces of our current system needed to be upgraded or replaced.We had components close to end of life, and there was enough forethought at that point in time to consider a wider scope than just the components that were coming to end of life. That thought process evolved into the EHR initiative, so rather than just replacing a repository, which was coming to end of life, in which the vendor was sold, we decided to embark upon a larger electronic health record (EHR) initiative, of which the repository component would just be the first step, and that’s basically how it began.

As far as evolution is concerned, the plan was to move from just the repository phase (phase 1) to then encompass ADT (admission, discharge, transfer), registration, scheduling and the emergency department, and we are in the midst of planning for go-live of those components even as we speak here today.

And then phase three is CPOE (computerized physician order entry), which we’ve done a fair amount of work on concurrent with ADT, and that phase is scheduled to take us toward the end of 2006. So there was a loose plan in place, and we’ve been making planned progress toward that goal, with some components taking longer, some shorter; but we’ve been making decent progress, and the CPOE phase, which is yet to come, is still continuing to evolve in terms of its scope.

HCT: What are the objectives and who are some of the other participants?

WT: Well the objectives ultimately, and these were reaffirmed last year, are really to improve patient safety and improve the quality of care and the efficiency of both financial and healthcare operations. So there are broad goals for the project, now that we’ve expanded the scope to include all of the components. As such, it really involves almost all of the key stakeholders within the hospital and the ambulatory environment, not just registration and scheduling and patient accounts focus, but the medical staff as well. So there are very few stakeholder portions of the environment that are not impacted and I would have to say that all of those areas have some participants in this process.

HCT: What’s the current status?

WT: The repository is live and our interface engine has been live and up and running for some time.We are literally eight weeks away from the go-live for ADT, registration, scheduling and the emergency department, so that is definitely the next milestone. Even while we are approaching that milestone, we are in the planning stages and some continuing low-level effort geared toward CPOE, which is immediately to follow. So it’s a critical time at the moment in the march toward this milestone, and we are planning for the next phase even while we’re doing it.

HCT: What are some of the challenges and what are some of the lessons learned?

WT: The challenges have probably been those typically associated with a large, very complex project. Turnover of staff and in some cases leadership positions that were instrumental in moving the project forward have been a challenge. Maintaining focus on the end goal when it’s relatively far away from your starting point, has been another typical challenge. I would also add the tendency to want to create the ideal environment as opposed to just getting a significant improvement over what your current state is. So those are some of the challenges. Lessons learned, in retrospect, you cannot spend too much time on the process of controlling scope and the discipline around that. Every large project has that, as a component, but I think that’s an area that can always stand to have more effort, time, attention and formality associated with it. Our project was no different.

I think the second area for lessons learned is really communication. There’s been lots of communication and there are both formal and informal pathways, but I think the formal integration of a communication plan into the project plan is probably a key lesson learned. This is opposed to having a separate communication plan with a separate group of people that might have had their eye on that. I think it needs to be key milestones with prerequisites and dependencies that do not differ from any other key aspect of the project. And I’d say that’s another lesson learned.