EHR Resource Planning (3) – Estimating Task Work and Duration

Estimating the work effort is the third blog in the multi-blog series on estimating resources for an electronic health record (EHR) project. The first blog, Introduction, describes the basis for these blogs and the series of blogs that will follow. The second blog, Defining Resources, discuses how to create the tasks and designate the resources roles assigned to the task in a resource assignment matrix (RAM). The third blog will use the RAM created in blog two and add work, duration and resources to the tasks.

Let's take a look at how to use your RAM to add work and duration for each task. The RAM (Appendix 1) lists all the tasks and resources needed to complete the tasks. The tasks from the RAM should be copied into a project management software application, such as Microsoft Project (Appendix 2). An additional tool to assist with estimating duration is a risk register (Appendix 3) which contains the identified risks. A risk is a positive or negative event that may impact the ability to meet the project objective. For example, if a particular task has a high risk probability then the duration or work for that task may need to be increased.

There are several task duration and work estimating techniques however we will focus on three which include: expert judgment, historical performance, and three point estimating. Expert judgment is generally used when no historical data is available from past projects and involves requesting individual team members to provide work and duration estimates. The second estimation technique, analogous estimating, uses historical information as the source for estimating duration and work. The last estimation technique, three-point estimating, involves gathering three estimates for each task: most likely, optimistic, and pessimistic. The next step is to combine all three estimates to come up with one single value. The most common method of obtaining an accurate single estimate is by using the Program Evaluation and Review Technique (PERT). PERT uses a formula in Microsoft Project that places an emphasis on the most likely estimate but still takes into account the pessimistic and optimistic estimates (Appendix 4). Microsoft Project only supports estimating duration with PERT however you may create an Excel spreadsheet and average the likeliest, optimistic and pessimistic work estimates and enter that value into the work column in Microsoft Project. Three point estimates will be more accurate than single point estimation and is recommended for estimating work or duration for tasks without expert judgment or historical performance baselines.

The next step is to attach the resources to your tasks. In order to complete this step the resource sheet in Microsoft Project must be populated from the resource names in the RAM (Appendix 5). Once the resource names have been transfer to the resource sheet than attaching the resource to a task is easy. From the Gantt view click the cell below resource name and the list of resources from the resource sheet will present. Select a resource name the resource will be assigned to the task (Appendix 6).

At this point, the RAM has been used to populate tasks and the resource sheet within Microsoft Project. Three estimating techniques for work and duration were discussed and resources have been assigned to tasks. The fourth blog in this five blog series will discuss resource calendar and task relationships to finalize the EHR project schedule.

Appendix 1 – Resource Assignment Matrix (RAM)

Task	Clinical		Technical			Clinical W/Technical Skills			Administrative
	Tom	John	Sue	Terry	Bob	Carol	Susie	Nick	George	Brian
Establish VPN connectivity			A	C	R				I
Review EHR vendor statement of work	C		C			C	C	I	A	R
Finalize future state workflows	A	R	C			I
Finalize interface specifications			A	R		C
Test all Interfaces	S		A	R		S

Appendix 2 – Copy tasks from RAM into Microsoft Project and add Resources

Appendix 3 – Risk Register

Appendix 4: Adding the PERT Analysis Toolbar

Appendix 4a: PERT Analysis View

Appendix 4b: PERT Analysis with duration estimates

Appendix 4c: Calculate duration based on PERT Analysis

Appendix 5: Populating Resource Sheet in Microsoft Project

Appendix 6: Assigning resources to a task in Microsoft Project (Click the cell under resource name)

Transitioning from Paper to an EHR

Achieving a goal to become truly paperless is not realistic. Not all systems from all hospitals, clinics, imaging centers and laboratories that touch your patients are fully electronic, and even if they were: they don't all willingly or otherwise integrate with one another yet. Interoperability makes for interesting discussions, but demands a period of definition, evolution, more definition, acceptance and finally adoption before we see true interoperability. Paper (even if scanned) will continue to be part of the patient/ provider experience for quite some time. Phasing the implementation should be considered when guiding providers and clinical staff on their path to become paperless. The learning curve and initial productivity impact of a new system can be minimized by following appropriate plans unique and specific to your existing processes, tools and overall tolerance for change. When implementing an EHR, it is important to pick the right components at the right time to leverage synergies and improve adoption.

There are many components that need to be considered, ranked and slotted in the rollout plan. Picking your battles and prioritizing are important while achieving implementation and "meaningful use" goals as quickly as possible.

The Components:

1. Data conversion options need to be confirmed. What historical data can be converted at what cost and in what time frame? How useful is the historical data and how far back do you really want to go considering storage and potential performance impact.
   
2. All potential real-time interfaces need to be confirmed and weighed based on clinical relevance, cost and resource availability to build and test. Which interfaces provide the biggest bang?
   
3. A decision needs to be made regarding the cost/ benefit of back scanning and whether to back scan at all using your own or third party resources. Third party resources tend to shorten the duration of a back scan project.
   
4. A Go-forward scanning solution of critical clinical patient information not available electronically needs to be defined.
   
5. Pre-population of current medication, problem, allergy and immunization list should be considered as well. Are there resources available to assist with this to ease the transition for providers?
   
6. Transcription – see previous blog entry regarding transcription options.
   

Contact us for more details regarding strategies that will help you align your short and long term focus with the most effective transition to less paper.