Peter and I would like to welcome you to module two in our course, Leading Change in Health Informatics. In this particular module, we will be focusing on concepts of project management that are important for all health informaticians to be familiar with. You'll be starting off by hearing about the different phases of a project, and I think there's a good case study that we can talk about regarding the first phase project initiation, something that we've been dealing with here. Peter is bringing voice recognition into the electronic medical record system. But before we talk about how we got there, let's step back and talk about what exactly the problem was. Sure. Well, the problem was identified because the dean CEO had convened a group to look pretty broadly at what were the joy killers of current medicine and what could we do at Johns Hopkins to restore a sense of joy in the practice of medicine. He really defined that pretty broadly for all clinicians not just physicians, but as you might imagine, the electronic record system, the epic system in particular came up as being one that is a very significant burden and that's borne out basically in any analysis out there, that for all that we had hoped to do and benefit with the record it turns out that in some ways the electronic record systems become something that detracts from the joy of practice which is heartbreaking. So, we asked a group to help us think about ways that we could help restore some of that joy, and one of them that came up was, "Please give us a way of implementing voice recognition." In our case what we had settled on was Dragon Medical One which is a cloud-based product that's made by the company Nuance. We had selected that system and began to frame sort of what should we do to try to get buy-in for that effort. Right, and can you speak a bit to that in making the business case? How did you go about doing that? So, it was an interesting challenge. Johns Hopkins with our new dean CEO, he has one very small groups, known as the Dean's committee, that meets weekly where a lot of these key decisions get made. So, I put together a two-page document literally back and front, and when I do this, I don't ever want to provide more than that because it's not going to get read, but it was succinct summary of why we're doing this, what our hopes are, reviews a little bit of what we have now. Importantly in this regard, there was no financial ROI. I know in the course we go into whether or not we can find our Return on Investment, and we could not identify that in this case. We said that in terms of being authentic in the proposal, there already was a way of doing transcription where you'd get your text back the next day, but importantly people really wanted to sit down at one time and get the benefit of it. So, I captured some key quotes from people who were asking for it and why they were asking for it and some stories I took, credible, literally grabbed some small quotes from very busy clinicians, who said, "I got home last night, I had not finished my charts, I was up until 10 o'clock at night finishing my encounters. I came on service, in the pulmonary division I had 25 patients, I could not get through the process." So, there was a recurrent theme of, "Please help me in one sitting to get down and communicate what's valuable." Very importantly for this particular technology in this project, it has this great benefit of helping both the people that are creating notes, but also the people reading them. So, there's this sense that we have lost the great narrative that we used to have. Maybe in retrospect, we overestimate how great the narrative was on paper, but there's a sense that it's hard to read charts, and so what this does is restore some of that narrative. Right. In making that business case and having your two pager, we talk about the importance of an executive summary because that's about the amount of time. You want to have the high yield information there, you have a few minutes, a little bit of an opportunity to get people's attention and you have to make that case. But having the end-users expressing their frustration, those quotes, that experience, that really makes the argument, especially when you can't demonstrate the financial ROI. So important. Yeah. Very important to get something in writing, that summary and just logistically and from a political buy-in perspective. I made sure I had a very small number of people in that room. I made sure that I had some key people who understood this project and we're ready to help advocate for it, because sure enough in the discussion, thankfully our dean CEO immediately said we just have to find a way to do this. There were some push back from some others in the room but very important from an initiation standpoint to think through how you're going to get that coalition to buy in. So, I had made sure that there were folks in the room who were going to be surprised and in fact were prepared to support the proposal being made. Now, with this particular project, can you speak a bit to the role of the project leads, how involved you were, and then maybe a little bit about the timeline? Sure. We did a lot of work. Getting the supportive leadership of the company and in general when you're rolling out a major system, I really like to come in way above the salesperson in the company to make sure we've got some executive support. So, that was really important to this process in terms of getting the vendor, the right people inside the vendor. Then secondly, it was important to identify people who were inside the REHR system or Epic system project, because they understood everything that was going to be required to identify how it fit into the workflow. Then next to get as we've talked about before, get a group of the physician champions who are not going to just advise on how it's going to be configured, but are going to really go out there and help to market and advertise the system and to train people. So, what we're able to do is run a pilot phase and it was pretty exciting because everybody wanted to be in the pilots. So, that's a nice way to roll it. Always a good sign. Always a good sign when you're getting the pull for the system. So, we immediately got oversubscribed interest in being a part of the pilot, and as a part of that, I extracted as best I could a commitment that, if you're in this, you'll help us roll it out further. That is really helpful because then you've got people that can tell these stories. Fortunately, it's getting easier to roll out technology if the technology is really good. In this case, the system is really good at recognizing voices including accents, including very difficult medical terms, and so that capability was new and interesting to everybody because in years past, it was really harder to get buy-in. So, that helped getting that pilot done, put us in a good position to do some marketing and to get some information out to the community and to create some buzz around, it's coming soon, and explain to folks what the process was good. Yeah. I think as we're talking about this particular project, we're touching on concepts covered elsewhere in the course as well. You heard Peter refer to the pull strategy, and when we're talking about push versus pull approaches to change. You'll certainly be hearing about some of the benefits of the pull and in this particular case, the various providers who were very interested in having this change brought on. Then we also talked about the concept of the pilot versus the Big Bang approach that you'll be hearing about. I have with me here a version of Hopkins Insider, which is a great way of communicating changes to vision strategy. This particular article says, "Dragon brings voice recognition to Epic," and it's a great user story on one of our faculty members who's a strong physician champion. "Hospital-based internist Timothy Neeson was skeptical, but he tried other voice recognition tools but found they didn't save time." But with the new one that was chosen it really is better and he was one of the individuals who was piloting the tool. I feel like this type of article is a great way of generating a short-term win, right? Absolutely. Yeah, that was, and he and several others did that. We also made sure that we had enough champions in different areas that they can take that message back. So, this is really one the more fun ones. When I look back over all of the technology that I've rolled out, I think maybe the one that brought most happiness with single sign on. Ironically just being able to save all the steps and signing onto a system, but this also one really caught a lot of interest in momentum. So, it's fun. It's good to have this kind of project because the next project that you have, might be one that involves some terribly complex compliance process that is not nearly as much fun. Probably have an email in your inbox right now talking about that upcoming one. I'm sure I do. But I'm personally very grateful for SSO. So, thanks for making that single sign-on happen. Hopefully, as you go through the different lectures in this particular module on project management, you'll be able to reflect back on the discussion we had about this particular project with voice recognition software. Over the course of this module, students will be learning about the different phases of a project, about some of the key terminology related to scope creep since not everything always runs on time, on budget and produces a quality result. You'll also be hearing about work breakdown structures, Gantt charts and they'll be having some opportunities to develop their own process flowcharts. So, we hope you enjoy this module.
