Making sausage--effective management of enterprise-wide clinical IT projects.

Unlike most other industries in which company employees are, well, company employees, U.S. hospitals are typically run by both employees (nurses, technicians, and administrative staff) and independent entrepreneurs (physicians and nurse practitioners). Therefore, major enterprise-wide clinical IT projects can never simply be implemented by mandate. Project management processes in these environments must rely on methods that influence adoption rather than presume adoption will occur. "Build it and they will come" does not work in a hospital setting. This paper outlines a large academic medical center's experiences in managing an enterprise-wide project to replace its core clinical systems functionality. Best practices include developing a cogent optimal future-state vision, communications planning and execution, vendor validation against the optimal future-state vision, and benefits realization assessment.