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A recent question directed to a medical imaging system (MIS) project manager raised a number of concerns for both the implementing vendor and the client: "Why is it that you are the only one who knows what's going on?" Talk about a loaded question!
Now, it's understandable that there will be a level of uncertainty with any new MIS project and that a number of natural questions will arise. This question was troublesome because the person who asked it was a senior leader within a leading health care organization and held a critical position on the core team for its MIS project Furthermore, the question was asked halfway through the implementation phase-a bit late for the trust required of all involved parties.
The moment quickly revealed an unstable project and highlighted the importance of understanding a project's scope early in the process, clearly communicating an implementation roadmap and, most important, having project buy-in from leadership. Ultimately, the question was a symptom of poor contract negotiations coupled with the absence of an effective MIS project charter.
As the project progressed, the frequency of questions and concerns increased exponentially, even spreading to other stakeholders (i.e. system super users), and frustration levels escalated on both sides of the aisle. The vendor was rapidly falling behind schedule and the client stakeholder was losing confidence in the project. Worst of all, a key MIS that was instrumental to the client's business plan wasn't even close to being implemented.
When the senior leadership decided to re-evaluate the project scope, they realized they had purchased a standard product package without thorough assessment of implementation methodology, project scope, vendor resource experience, or even a basic understanding of the project roadmap.
 Product packages
Many MIS companies offer pre-packaged solutions containing options based on typical organizational models. But, examine all components of a package to make sure they're relevant to your organizational, technical and clinical needs. A single-physician office with computed radiography and an ultrasound unit has different requirements than a large integrated delivery network offering all medical imaging and cardiology service lines.
For instance, don't waste money on things like licensing bundles that will never be utilized. Conduct a current-state assessment to capture areas of need and provide exact numbers for licensing purposes.
Implementation methodology
There are numerous implementation methodologies utilized by MIS vendors and health care organizations. If your organization has an active project management office (PMO), this group is most likely to be involved in the implementation methodology discussion. If, however, there is no PMO, then methodology discussions need to take place during contract negotiations to ensure that the vendor agrees to comply with organizational expectations and culture. If mutual agreements are not reached before work begins, the project core team will consistently experience conflicts between existing processes and new methodology driven by the implementing vendor, ultimately creating project delays and adoption risks.
It is absolutely imperative that a MIS is fully understood and formally accepted by senior leadership for early buy-in, which will lead to successful adoption.
Project scope
Also during contract negotiations, determine a clear project scope and related out-of-scope components. Additionally, a scope of vendor engagement should be agreed upon and documented in the final contract. As a customer, it is important to see an itemized list of "professional services" offered to measure the cost and to understand exactly what you're paying for. Your organization may be able to cover half of the professional services internally and avoid the unnecessary cost. Defined scope also will keep both parties accountable and will provide healthy direction for the project.
Resource experience
Let's be honest-every company has its premium teams and its secondary teams. During contract negotiations, ask about the experience of the team being assigned to you. Keep in mind that you are not the only contracted customer and you will not be assigned a top team unless you require it. There is no greater risk to a project than to have an inexperienced project manager, especially with a pilot project.
Project roadmaps
You must have a clear understanding of the overall project roadmap so you can keep the vendor honest and establish timely planning for your internal resources. Weekly status calls will feel like weekly "punch lists" for your leadership and the project team. A healthy project will always encourage early stakeholder engagement with complete understanding of the project roadmap. As a result, key stakeholders will act as coaches and be the first level of response for the internal teams. Having an early understanding of the product functionality and its impact on users also should fall under early project roadmap education.
Due diligence
With your next MIS purchase, don't be lured into a standard package. Establish a steering committee with appropriate leadership and subject matter experts to objectively review and evaluate a number of vendor proposals. Prior to vendor engagement, set aside some time for proper assessment of your clinical and technical needs to have a baseline for your purchase. Be aggressive during contract negotiations, and don't ever hesitate to question proposed product and service packages.
Valentin Kapitula is a senior consultant at Ascendian Healthcare Consulting, based in Sacramento, Calif.
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