The document summarizes Premier Health's journey to implementing an enterprise-wide Project Management Office (PREMO). It describes how before 1999, project management was not formalized and metrics like being on-time and on-budget were only around 20%. Two events - Y2K and an EMR implementation - showed the need for change. An IT PMO was established in 2008 which improved metrics to 80%+, but the organization continued changing. This led to approving PREMO in 2017 to provide centralized project portfolio management across the system and optimize resources. The implementation of PREMO is ongoing with challenges around adoption, perceptions, resource management and change management.