By Joseph Goedert, News Editor, Health Data Management For many big information technology projects these days, a cross-functional team representing various departments plans and oversees the efforts. This approach is essential to success, says Greg Walton, CIO of El Camino Hospital in Mountain View, Calif. El Camino in July will reopen recently acquired Los Gatos (Calif.) Community Hospital, extending its information systems to the second facility. Then in October, a new El Camino Hospital will open. It gets worse. Laboratory, surgical, radiology and pharmacy systems at El Camino are being upgraded or replaced, then extended into the acquired and new hospitals. So that means there are cross-functional teams within the cross-functional teams that are handling those systems. With all the issues on El Camino's plate this year, it falls to cross-functional teams of hospital supervisors, managers, directors and senior executives, plus community volunteers and government officials, to make sure all the bases are covered. For instance, clinical programs at Los Gatos will be the same or quite similar to those at El Camino. That means the policies will be the same, but procedures and workflow processes will differ because of the difference in the physical layouts of the facilities. And several cross-functional teams need to figure out how to make that work smoothly. "The number 1 thing you have to focus on is who's leading what aspect," Walton says. "It's really important to have clear leadership." That leadership includes project managers leading each team and getting help when needed from vice presidents, with C-level executives coming in if necessary. Cross-functional teams at other provider organizations have their own share of challenges. Some are working on joint initiatives with other organizations. While larger hospitals typically have several teams involved in an IT initiative, very small hospitals, such as 18-bed Steele Memorial Medical Center in Salmon, Idaho, may only have one team handling all issues. Another small facility, Watertown (Wis.) Regional Medical Center has super-users on its cross-functional teams, each of whom signs an agreement specifying what is expected of them and of the administration. But all cross-functional teams have one critical mission in common, Walton says. "I have learned above everything else that this is a giant communications and coordination job. If you don't have everybody at the table with an interest in what's going on, ultimately it'll bite you." And it's a job being made a lot easier these days with collaboration software such as Microsoft Corp.'s Share Point that is used at El Camino, he adds. The software manages business processes, content and the sharing of documents and other information to support a project. "Without these kinds of tools, there's a lot more work involved," Walton says.

In general, cross-functional teams comprise representatives from various units across an organization that would be affected by any given initiative. They are split into teams that tackle specific issues. A bedside medication management administration system implementation, for instance, may have separate teams to map out how the system will affect the pharmacy, obstetrics, inpatient, emergency, surgery and IT departments, plus physicians. Physicians and other clinicians often are under-represented on cross-functional teams unless their supervisors set time aside to let them work on the teams, says Abner King, CIO at Steele Memorial Medical Center in Idaho. "It's very difficult to get physicians because they want to focus on their patients and do their job," he adds. Team members can work for considerable periods on an initiative, and this work is in addition to their regular duties. To the extent possible, many organizations try to lighten the workloads of physician, nurses and other clinicians on these teams. But not all IT initiatives have clinical participation in cross-functional teams, says Dale Sanders, vice president and CIO of Northwestern Medical Faculty Foundation, a 600-physician group practice in Chicago. Projects involving clinical applications and how data is managed have significant clinician input. But projects covering hardware, operating systems and networks don't necessarily require clinician involvement, he contends. "If we're going to upgrade data storage, we're going to notify clinicians but don't really expect them to participate," he says. Many IT projects have a multi-tiered system of cross-functional teams. Lifespan, a Providence, R.I.-based delivery system, started planning for a new lab system, integrated with the hospital information system and laboratory robotics, for its four hospitals in August 2006. The system went live in June 2008. One of the four facilities, Newport Hospital, has reached the Stage 6 level of adoption of electronic health records, as measured by Chicago-based HIMSS Analytics, a market research and consulting unit of the Healthcare Information and Management Systems Society. The executive sponsor group that oversaw Lifespan's four-hospital lab initiative comprised the senior vice presidents of shared services and operations, the vice president of finance, and CIO Carole Cotter. The labs report to the shared services department, so the director of shared services was the project sponsor. Cross-functional teams included lab managers, lab builders, lab system managers and IT personnel. Teams had to oversee the building of master files for the new lab system and draw up test plans for various modules of the system. These included blood bank, immunology, toxicology and microbiology, among others. They also worked on integration plans so clinicians could view results in the clinical information system. Other participants included representatives from pharmacy, nursing, emergency, transplant, critical care, the residency program and infectious disease. Among other duties, they ran integration tests to mimic real-life situations. For instance, Cotter says, the pharmacy needs to consider lab test results when looking for adverse interactions. The cross-functional teams also included representatives of the lab system vendor, which is a common practice. Sometimes, these vendor representatives can become good advocates for the customer, Cotter says. "They speeded up vendor response to problems," she notes. "Response was not satisfactory at first, but vendor members went back to the company and said, 'We've got to step up.' They were really our advocates back at the home base." And that's because vendor members of cross-functional teams weren't just hearing about problems; they saw the problems for themselves, she adds. It's important to interview those the vendor is designating to serve on teams, Cotter says. "We test their knowledge of the product. You would be surprised how often you buy a product and the people who show up are not familiar with their own product." It's also important to know if these vendor representatives have the ear of their own senior executives, she adds. "If they don't, it shows up quickly in the project team." She recommends asking the vendor project leader how influential the other vendor representatives are.

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