Article Preview
TopIntroduction
Health Information Technology (HIT) is one area where governments and healthcare organizations continue to spend money with the hopes of improved outcomes and reduced costs. Taken alone, a project characterized as information technology (IT), healthcare, or inter-organizational, would likely be classified as a complex project. When these characteristics are aggregated under one project, we have a formidable challenge, particularly when the project goal is to produce a sustainable service or work flow. It was reported in the literature that 91% of HIT projects fail (Maxfield 2007). These HIT projects affect not only those employed in the healthcare industry, but also the majority of citizens that seek healthcare for themselves or loved ones.
Various business best practices, such as LEAN and project management tenants promoted by the Project Management Book of Knowledge (PMBOK) are increasingly being applied to the healthcare context to support the success of change efforts. Research in applying and adapting these best practices grounding in other domains is still in the early stages in the healthcare sector (Chiocchio et al., 2012; LeRouge et al., 2010), though the value of project management best practices for the healthcare sector is increasing in recognition (Deutsch, Georg Duftschmid, & Dorda, 2010; Gertner et al., 2010). Telemedicine service lines are among these complex HIT projects. The start or expansion of a telemedicine service line is intrinsically collaborative as it requires both intra- (IT, administration, clinical) and inter- (hospital A, hospital B) collaboration efforts coming together to provide distance-based medical care using telecommunications technology. In addition, these initiatives operate within a complex legal, policy, and standards environment that can impose constraints as well as ambiguities. Different components, some inside the organization and others in the external environment, need to be orchestrated from the beginning of the telemedicine project to avoid issues in implementation and to provide a foundation for a service line that is sustainable beyond the project end date (where project activities are moved into standard operational process). The recommended first stage in any project is the initiation, also called project definition or conceptualization. This stage (or process group as referenced by the Project Management Institute) has been categorized as the most crucial step in the project (J. Knutson, 1999) and a key element for project success (Merla., 2009). Project definition moves organizations from strategy to execution.
The project management discipline provides best practices and guidelines for project initiation. Although project management tenants are applicable for different fields, the telemedicine field includes few studies that link project management concepts to the application of programs. Further investigation is necessary to determine the need for contextualization and adaptation of these tenants to best suit and benefit the healthcare sector. Telemedicine initiatives may be short-lived, if they are not built on a strong strategic foundation (LeRouge et al., 2010), which starts with project initiation activities and decisions. Unfortunately, little is known about the underlying nature of project initiation in telemedicine projects.