Background on the Waterfall Clinic

The construction of the Clinic Health Records Information System (CHRIS) for the Waterfall Community
Health Center is a high profile project for Neitown. The city had a period of intense growth in the 1940s
while supporting the war effort through its textile mills and uniform producing factories. After the war, the
local businesses did not adjust quickly enough to the changing economic climateas clothing and textile
production moved overseas. Today Neitown has many empty factories, high unemployment and is
struggling to grow.
The Waterfall Community Health Center provides high quality, low cost health care to many of the
communitys unemployed and other low income families with no health insurance or health plans with
high deductibles. The clinic is central to the health care of many of Neitowns residents. To offset the cost
of the discounted medical services, the clinic receives numerous federal and state grants.
The clinic has been operating at capacity and needs to expand its facilities. Their current electronic
health record (EHR) system has reached its end-of-life and the company that developed the software is
no longer in business. The clinic has secured federal and state grants for expansion of its physical
facilities and the development of a new electronic health information system, CHRIS, to replace the
current EHR system. To receive the full state grant for CHRIS, it must be operational by the end of the
states fiscal year.
The clinic CEO, Maria Jones, continuously looks for innovative solutions to community health issues and
expects CHRIS to maintain information on provider (doctor) productivity, statistics on patient population
health and streamline billing, improving the finances. Her staff considers her a Type A personality. Her
past successes in health care innovation have given her tremendous sway with other health centers in
the area. If CHRIS is successful at the Waterfall Clinic and earns Marias endorsement, it could lead to a
additional contracts at other local health centers.
The board of directors for a community health center has governance authority over the health center.
While Maria is responsible for running the daily operations of the clinic, the board is responsible for
approving policies, operational oversight and strategic decisions. A project the size and impact of CHRIS
requires board approval and board oversight and so we must keep the board apprized on any issues that
impact the cost or schedule.
This project is critical to continued operation and success of the clinic, but it is not without controversy. A
year ago, another clinic received a large state grant to upgrade their EHR. The project was poorly
managed and, in the end, it was cancelled, costing the state millions of dollars. The state is predicting a
budgetary shortfall this year and there have been many protests at the state house to cut or cancel
funding for this project.

The Current Situation

There have been many delays in this project. Approval of the state funding, which is needed to complete
the project faced many hurdles in the states Department of Health and Human Services, DHHS, as well
as in the state legislature. Despite the delays, the required implementation date has not moved since the
funds the state has promised for the project are tied to federal funding for EHR and patient portal projects.
Patient portals provide patients online access to their electronic health care information and is a required
feature for the new system to receive the funding.
Now, as the clinic is ready to begin development, the prime contractor for the system has filed for
bankruptcy and must be replaced. The bankruptcy of the previous contractor has further eroded public
confidence in the project. Our company, Neit Tech Technology, has been hired by the clinic to develop the
system, manage the project and supervise the subcontractors.
A schedule challenge we face throughout the project is the time sensitivity of the state funding. If the
project is delayed significantly, the funding will be greatly reduced or eliminated.

Project Overview
PROJECT DESCRIPTION
The Waterfall Clinic CHRIS project seeks to construct a new comprehensive health information system for
the community health center while meeting all deadline and budget targets. Thisinformation system will
be core to the functionality of the clinic providing administrative and medical staff timely and accurate
information critical to patient care.
The goal of this effort is to build a comprehensive health records information system that includes patient
and provider scheduling, electronic health records, a patient portal and external interfaces to insurance
providers as well as state and federal agencies. In addition to the core system, we will convert patient
history data from the existing EHR to pre-populate CHRIS and train clinic staff.
PROJECT EXCLUSIONS
The scope of the CHRIS project is limited to construction of the above listed information system modules,
conversion of existing system data and training clinic staff in use of the system. Higher capacity servers in
the clinics data center/server room will be provided. Hardware for clinicians and office staff will not be
upgraded as part of this project.
PROJECT CONSTRAINTS
Constraints that limit the scope of this project include the project budget and the schedule, which requires
a six-month project timeline, excluding the two-month planning timeline. Failure to meet the scheduled
delivery date results in loss of state economic development funding for the project.
PROJECT ASSUMPTIONS
All proposed changes to project scope must be subjected to a change control process.
The clinics budget is already under significant pressure, and cost overruns greater than 1% will require
written approval by the clinic board.
The project will be reviewed periodically by a state Department of Health and Human Services oversight
manager.

The Stakeholders
Here are a few of the key stakeholders on the project:
Marco Padula - Chairman,
Waterfall Clinic Board of
Directors

Samantha Reagan - State Health and

Human Services Department EHR
oversight officer

Maria Jones - CEO of

Waterfall Community
Health Center

Marsha Tucker - State Department of

Health

Felix Gosselin - Waterfall

Clinic Chief Operating
Officer

Quana Mankor - Waterfall Clinic

Patient Advocacy

Justin Bryne - Neitown

Consumer Protection
Alliance

Victor Nguyen - Neit Tech

Technologys Health Care Information
System Program Director

Padma Rodriguez Neitown Chamber of

Commerce

Preparing the Stakeholder Register

Since a significant portion of this projects funding comes from a controversial state grant, the Waterfall
Clinic CHRIS project will have high visibility with taxpayers and government watchdog groups and will
present technical complexities as well as budgetary challenges. You are excited about the opportunities
that lay ahead with the project, but you also know that you will face some unique challenges. To prepare,
you decide to read up on gaining public trust on projects.
You've just finished reading portions of the reports, when Jason Marks knocks on your office
door. Marks is an outreach specialist who also works at the state department of health
regulation. You've been working with Marks to schedule a series of staff and patient user
input meetings that have been planned for Friday mornings.
Marks sits down across from you and hands you a document. "In anticipation of the staff and public input
meetings, I've put together a modified stakeholder register," he explains. "It includes all the parties that
have an interest in the CHRIS project, and based on what I know about them, their expectations.
See Handout: Jasons Stakeholder Notes on course web site
"Because I work for the state, all documents I create are considered public records and any citizen can
ask to see them under the state's Freedom of Information law. So unlike a stakeholder register that a
project manager might create in the private sector, mine doesn't include anything about the stakeholder's

potential level of influence, and whether they are likely to be a project supporter or a project resister.
Putting that sort of information into a public document would be asking for trouble."
"We can have an informal conversation about the stakeholders and their relative levels of involvement
and influence," Marks said. "I'll give you my initial impressions. Samatha Reagan, the Department of
Health and Human Services major projects oversight manager, controls the federal purse strings for
program that supplies the state funds for EHR projects. The good news is that she very much wants the
Waterfall CHRIS project to succeed. Marco Padula, the Chair of the Waterfall Clinic Board of Directors,
has a keen interest in the project and is particularly hopeful that the Patient Portal is easy to use and
provides help access for the clinics patients. He is a clinic patient and is very influential in the state
capital since he formerly was a state representative for the district that includes the clinic.
"Who may have issues with the CHRIS project? James Thistle, the clinic medical director, is well
regarded by the Waterfall Clinic staff and has raised concerns to the clinics Board of Directors in the past
when he thinks something will impact the clinic staff. Though the clinic is not a union site, some have said
he has as much influence as a local union president would. Hell be watching us very closely. Another
player who will be very focused on the project is Quana Mankor of the Waterfall Clinic Patient Advocacy.
She will be very outspoken if she thinks the project is going to severely impact patients, such as causing
longer wait times for appointments or HIPPA privacy violations. She isn't as well connected as James in
Neitown, and she's only been chair of the advocacy group for six months. We also need to recognize that
many clinic staff are unhappy about the project and worry that it will hurt productivity resulting in poor
quality of care for patients, higher stress and lower bonuses.
Just as Marks pauses, your phone rings and you excuse yourself to answer it. James Thistle is on the line
with an urgent matter. You put him on speakerphone so both you and Marks can participate in the
conversation.
Thistle begins: "Looks like I've got just the people I want to talk to on the phone. I know you are planning
several user group meetings for the CHRIS project."
Thistle continues, "That's great, but the fact that you've scheduled these get-togethers for
Friday mornings has really left the pediatrics team out in the cold. Friday mornings, our
pediatric team is off-site at the local school-based clinic. These doctors and nurse
practitioners are going to be one of the most heavily impacted groups once the system
goes live, and you're not acknowledging and adjusting to their schedule!"
There's a long pause, and then Thistle speaks again. "There's no way they can make it to your Friday
morning meetings. I'm getting together with some of the key pediatrics staff again tomorrow afternoon to
discuss the CHRIS plans and what it means for them. So I will need to know by tomorrow morning what
you plan to do to address this situation.

Team Deliverable
Your deliverable for next week has three parts:

Part 1: Project Charter

Use the Project Charter Template from the course web site.

Part 2: Stakeholder Register

Use the Stakeholder Register Template from the course web site.

Part 3: Team Resume

Even though theclinic CEO, Maria Jones,has hired us, we still need to get the board of directorsto
approve the change. The previous contractor was a local business, so the board of directorswas willing
to overlook some minor (major) weaknesses in the company. We need to demonstrate an ability to
manage this project to the board of directorsat next Monday evening's meeting.
Gather together resumes of your management team members and submit those along with an executive
summary highlighting related projects (if any) or other interesting/challenging projects on which your team
members have worked.
The clinic board needs to approve significant contract changes, such as our role as prime contractor, so
we need to provide an executive summary that contains a scope summary and a management team
resume. The team resume should give a brief biography of each team member, identifying the experience
and skills you bring to the team.