To meet EHR meaningful use, look to practice managers

When the meaningful use incentive program was announced, Jean Sanders knew she had a big job ahead of her.

In her role as practice manager of Aquidneck Medical Associates in Newport, R.I., Sanders knew she would be the one reading through the regulations, attending the various workshops and doing the bulk of the legwork required to get the practice up to speed to meet meaningful use requirements.

Aquidneck is like many practices in that the person who understands most intimately what financial impact a program such as meaningful use will have on a practice's bottom line is not the physician owners but the practice manager. So it stands to reason that the practice manager will be the one who takes the lead in ensuring that the practice qualifies.

But that doesn't mean physicians aren't involved at all. It just means the line of communication between practice manager and physicians needs to be open, and the role each will play needs to be defined clearly.

“A lot of what the physicians don't want to do is read every regulation and figure out how to implement systems to record everything that needs to be recorded to get to meaningful use,” said Sanders, whose title includes clinical project manager. “The practice manager's role is to take the regulations and put them in some kind of reasonable format so that the practice can then determine what has to be set up within the practice.”

Practice manager's role

The role of project leader usually falls to the practice manager because he or she is the only one who can build the responsibilities into daily workloads, said Allan Ridings, senior risk management and patient safety specialist for the Cooperative of American Physicians, a physician-owned risk management firm in California. For physicians to take on these responsibilities, they probably would have to see fewer patients or work longer hours. A practice manager has more time to digest the information and provide bullet points to the physicians.

Experts say that in the role of project leader, the practice manager will take on four primary jobs:

Become educated. The first thing a practice manager needs to do is learn the ins and outs of the meaningful use program, said Noelle Parker, meaningful use and health IT program manager for the Missouri Primary Care Assn., a consulting and quality improvement association for community health centers in the state. They must know why the program is important, because it will be the practice manager's role to “sell it” to other staff members, she said.

Assemble a team. Even though the practice manager will teach and explain the program to others, other staff members must carry out the actual plans. This means assembling a team that will share the passion — and spread the excitement to the respective departments throughout the practice.

In most cases, Parker said, every department from the front desk to the clinical staff will have a role in achieving meaningful use, so each department should be represented on the meaningful use team.

Develop a plan. Once the team is assembled, either formally or in more of an ad hoc fashion, the members of the team, including the physicians, will help the practice manager assemble a plan for action. This is the phase in which goals are set and a list is made of what needs to be done and how it will get done. The practice manager will facilitate the goal-setting and figure out what role each team member's department will play in carrying out the plan.

Ridings said the plan should include role-playing scenarios for when things go wrong. Think of anything that could throw the original plan off course and develop ways for how those situations will be handled.

Monitor progress. Ridings said many practices rely on charts and time lines to track progress. But the team needs to meet regularly to go over progress reports and figure out where additional resources might be needed or where certain departments or employees might be struggling.

It also will be up to the practice manager to do regular test runs of reports that will be needed for meaningful use to determine how close the practice is to meeting certain objectives. “Once you get up and running, you want everyone looking at those reports,” Parker said.

Physician's role

With the practice manager developing the plan for meaningful use, the primary role of the physician will be making sure the practice is ready for the job by doing two things:

Leading the clinical team. For physicians to stay on top of what is needed, they must become important members of the team the practice manager has assembled. In many cases, Ridings said, physicians oversee the tasks done by clinical staff, and practice managers oversee nonclinical staff, so those two groups represent the “team.”

That was the approach Sanders took by assembling a team that consisted of herself and all 13 of the physician partners, who met on a regular basis before the program launched. Experts recommend that physicians meet with the practice manager and the entire team at least twice a month to stay on course. It will be up to the physician champions to relay the action plan back to other physicians, nurses and medical assistants.

Supporting the practice manager. During the preparation for meaningful use, staff may be moved around, money may be allocated in different ways or jobs will change to accommodate new work flows. Physician support is key to getting these things done, Parker said.

Support also can come by helping practice managers make decisions, especially those that will affect patient care. Sanders said at Aquidneck, one of the things that needed to change after implementation of an electronic health record system was that patient education materials had to come from within the EHR. Physicians were asked to look at and analyze several examples and choose the best resources.

Ultimately, as the owner of the practice, the physician is in charge. He or she will be the one whose name is attached to the meaningful use attestation documents. But if doctors have practice managers who are sharp and stay on top of developing changes within the health care landscape, the managers know what it will take to get the practice to meaningful use. And they will accomplish this by doing what they do best: manage.