Seven Stages Of Implementing An EIP 03062015

2015-05-08

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EXECUTIVE BRIEF

Hiring the Right Enterprise
Imaging Consultant the First Time
Overcoming the Seven Stages of Implementing an Enterprise Imaging Platform
By Trent Conwell, IT Director, Sentara Healthcare

Technology expertise within the IT department is not a
sufficient skillset to ensure successful implementation
of an Enterprise Imaging Platform. IT not only needs
to understand the underlying technology of the vendor
product, but how that technology will integrate with every
other technology within the organization. Add to this the
need to understand the impact on clinical, operational, and
technical workflows, tight timelines, and no tolerance for
budget overruns and you have a very complex environment
to manage.
Sentara started exploring Enterprise
Imaging and Vendor Neutral Archive (VNA)
strategies in 2009. We went out on our
own to find the right solution and the right
vendor because that process had always worked in the past. Our
initial effort ultimately failed, primarily due to our approach of
treating this selection process, as we always had, as if we were
buying a new software application. We learned that above and
beyond a technology solution we needed to understand what
our strategy was going to be. We wanted to address radiology
PACS, of course, but we also wanted to address other “ologies”
that were producing images. And long term we wanted to build
relationships with software vendors and a consulting vendor that
would allow us to define and design an HIE platform specific to
imaging.
On our second attempt, we brought in a consulting vendor with
expertise in the area of VNA technology. But again, the result
was failure. This was due in part to our narrow focus on just the
technology and in part to the vendor landscape. During this time
period the “Neutral” component of the VNA vendor solutions did
not quite exist. Generally, VNA vendors provided the archive and
the viewer and were in a partnership with a storage vendor to
provide the needed storage. The nature of this approach made it
difficult to produce a positive ROI on the TCO for the project.
I didn’t see this coming.
Before making a third attempt, we had many internal discussions
to determine what we needed to change in order to make this
attempt successful.

888-87-MACH7 | www.mach7t.com
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I thought we were equipped to deal with budget constraints,
a small staff, complex technologies, intricate integrations,
enterprise-wide impact and an ever-changing vendor landscape.
But because of the first two failed attempts I began to realize we
had to deal with something I don’t like to admit I possess.
Emotions! Not just mine but those of just about everyone
involved in this complex project. Identifying, understanding, and
managing our emotions was going to be a necessary step in order
to move forward successfully.
Most of us, at some point in our lives, have become familiar with
the Kübler-Ross model describing the five stages of grief. After
going through an Enterprise Imaging Platform implementation,
I defined a similar model that I call the Seven Stages of
Implementing an Enterprise Imaging Platform™.

1) Ignorance
While most of us refuse to admit that we don’t
have enough education on the subject, the
earlier that you come to this conclusion and
seek help, the more successful your project
will be.

2) Frustration
If you went through an education phase, your
frustration is normal and stems from the fact
that you did not understand how complex this
project was going to be.

3) Confusion
This is generally the point in time where you
start talking with vendors. Some vendors
may cause you to question the value of the
education process you went through.

4) Overwhelmed
As you start to sift through the Confusion
Stage, you immediately enter the
Overwhelmed Stage. This stage is much
like the Frustration Stage; the difference
being education leads to understanding
the true complexity of the project, and thus
overwhelmed.

5) Frightened
This stage is directly related to contract
signing. I call this stage: where hope meets
reality.

6) Hopeful
There is actually a fork in the road when you
get to this stage. While I have chosen to be
positive, it is entirely possible that stage six is
Dreadful and not Hopeful. Generally, you will
know based on how the testing efforts are
proceeding.

7) Success
Once again, I have chosen to remain positive,
because as we all know the alternative is
Failure.

There are many individuals and groups that influence the degree
to which you experience each stage. In my experience, I found
that I was the biggest influencer in many of the stages. However,
you will be influenced by members of your internal organization,
existing vendors on whom you must rely and, of course, new
prospective vendors who will influence you every step of the
way.
Understanding the Seven Stages of Implementing an Enterprise
Imaging Platform allows you to better understand the type
of help you will need to be successful. For many who are
seeking consulting help, their first thought is to find technology
experience. Actually, my first thought was to seek a staff
psychiatrist. Although this might have made me feel better
along the way, it probably would not have made our project
more successful.
What’s so complicated about Enterprise Imaging?
The process of vendor selection for an Enterprise Imaging
Platform should be overwhelming. If it is not then you probably

are not considering all factors in your decision (see Ignorant
phase above). While I am not necessarily proud of the fact that
it took three attempts to get our business case approved, what
we learned in the first two failures was quite valuable. First
and foremost, had we been successful in either of the first two
attempts we would have made the wrong vendor decisions. For
us, failure was humbling. It forced us to reevaluate our process.
When we could not find any major flaws in our process, it was
then that we realized we needed help. Remember earlier, when I
discussed the Ignorance Stage, and how you may not realize that
you are in it? That was us. So, to answer the question of “What’s
so complicated about Enterprise Imaging?” the answer is not
realizing how complicated it is.

FIRST AND FOREMOST, HAD WE BEEN
SUCCESSFUL IN EITHER OF THE FIRST TWO
ATTEMPTS WE WOULD HAVE MADE THE
WRONG VENDOR DECISIONS.
Getting out of the Starting Blocks
Consulting engagements don’t always get
the desired results. I am sure many of you
are reading that and saying: “That’s an
understatement.”
We needed a consulting firm that understood where we were
going and could get us there successfully. The answer for
Sentara was Ascendian Healthcare Consulting. Ascendian came
onsite and spent several hours with us over multiple days to
understand our objectives, constraints, and concerns. Within
a week of those visits Ascendian provided a statement of work
document that read like a book. The table of contents took us
through each phase of the project. As I look back at my Seven
Stages I realize that I went directly from the Ignorant Stage to
the Overwhelmed Stage, completely skipping the Frustration
and Confusion Stages. I gained confidence that Ascendian was
going to meet my expectations and provide a level of value that I
was just starting to understand was necessary.
Gaining Momentum
Ascendian started with an extensive education process. We
discovered details we would have never known we needed to
learn. While I thought that we had skipped the Frustration and
Confusion Stages, I discovered early in the education process
that I was wrong. However, with the knowledge we gained
during the education process we then had the knowledge to
eliminate much of the frustration and confusion we dealt with in
our first two attempts. Additionally, we had a team in Ascendian
that would help us cope with the frustration and confusion that
was to come.

Many Forks in the Road
Building an RFP is a daunting task. You
are creating a legally binding document
in which the prospective vendor must
answer each of your questions. If you
think about it, in order to get all of
the information you need, you must
be quite knowledgeable in every
aspect of the RFP. While this may
seem somewhat obvious, a well-written RFP must force every
response to be clear, concise, complete, and unambiguous. The
only way to know if your RFP is well written is to send out the RFP,
interpret the answers you receive, and determine if each answer
is clear, concise, complete, and unambiguous. But, since this is
not an episode of Jeopardy, where you get the answer before
formulating the question, we needed the expertise of Ascendian.
One of the strengths of the Ascendian team was their experience
in writing RFPs. What I did not expect was the unique and robust
process that Ascendian used during the entire RFP process. It
was interesting to hear from multiple prospective vendors that an
Ascendian RFP will be the most thorough RFP requiring a detailed
response.
The Ascendian RFP process allowed us to eliminate many of the
forks in the road, several of which we didn’t know existed.
We’ve eliminated the forks, but now we have road blocks.
The Ascendian RFP process resulted in a shortened list of vendors
that we had confidence would allow us to make correct vendor
choices. Having eliminated many of the
forks in the road we were now starting
to encounter more roadblocks, many of
which were internal.
At this point in time, we were building
our business case, a business case that
would have to provide a significant
ROI, because a large portion of the project expense would be
for technology below the water line. I believe this is where the
Ascendian expertise provided the greatest benefit. Ascendian
had worked so closely with Sentara that we were able to sit down
and define tangible leverage points that would ultimately lead
to the approval of our business case and the signing of contracts
with our selected vendors, Mach7 Technologies and Client
Outlook.
I see a light. Is it the end of the tunnel or a train coming?
Enter the Frightened Stage. Mixed emotions are generally
felt right after signing a contract. This is the point in time, as
I mentioned above, where hope meets reality. However, I can
say with complete honesty that, with the help of our consulting

partners, I was quite comfortable with our vendor selections. The
thorough RFP process and the relationships we built with Mach7
and Client Outlook were minimizing the effects of the Frightened
Stage.
The initial SOW with Ascendian did not carry beyond contract
signing. But it was clear that the teams from Mach7, Client
Outlook, Ascendian, and Sentara worked so well together during
what could have been very trying times, we should continue to
use Ascendian during the implementation. This is not to say that
our two vendors were not completely capable of getting us to a
successful implementation, it is to say that Ascendian has become
part of the Sentara team and offered additional perspective
related to the operational impact of deploying enterprise imaging
technologies.
Final Thought
Technology should always be at the forefront of your decisionmaking process. But, there are many additional factors to
consider when developing your Enterprise Imaging Platform
strategy. Using Ascendian Healthcare’s services was a critical
first step in finding the two vendors, Mach7 and Client Outlook,
and to reaching the decision that would allow Sentara to realize
success implementing our Enterprise Imaging Platform.
_______________________________________________

About the Author
Mr. Conwell is an IT Director at Sentara
Healthcare responsible for Technical Services
in imaging, laboratory, patient identity, and
EMR Integration. He has been in Healthcare
IT for over 25 years, 19 of which have been
at Sentara Healthcare. Trent’s years of
experience in integrating clinical systems across the enterprise
and knowledge of the patient identity strategy give him the
necessary background to develop an enterprise imaging solution
that meets Sentara’s needs. He also holds a Bachelor of Science
degree in Computer Information Systems.

For more information on the companies referenced in this
Executive Brief, see the following links:
Ascendian Healthcare Consulting: www.ascendian.com
Client Outlook: www.clientoutlook.com
Mach7 Technologies: www.mach7t.com
Sentara Healthcare: www.sentara.com

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Seven Stages Of Implementing An EIP 03062015

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