Quality/Operations-Led Meaningful Use Program

Bio_BethPart 3 – Embedding MU in Daily Operations

By Beth Houck, VP of Client Services, SA Ignite

When Meaningful Use (MU) began, there was little consideration given to housing the program in any area of the organization other than Information Technology. However, with some experience under our belts, many organizations have found that staying on top of the program means leading the effort from another area of the organization such as the Quality department. In our work with over 50 organizations, we’ve seen this accomplished with a few significant differences in comparison to an IT-led initiative.

Why change if it isn’t broken?
The initial MU undertaking was large enough that it almost seemed incomprehensible for one of our clients to consider moving responsibility for the initiative to their Quality group. Even with that in mind, however, there were a number of things that drove the final decision.

First, quite simply, the IT department was swamped. The group was considering a replacement EHR, was tackling the impact of ICD-10 and was tasked with absorbing several new sites, on different EHRs, into their practice. Something needed to give and as one of the initiatives that had already crossed departmental lines, MU was a reasonable candidate.

Second, during the initial MU roll-out, the IT trainers had underestimated the effort involved in convincing providers to follow the workflows to meet MU. The IT department was accustomed to training providers on how to do something but were unprepared for the amount of questions they would get about why they should do it.

Third, leadership knew that they needed to build the MU initiative into the fabric of their organization or it would always be something that providers “have to do for the government.” To the extent that providers still viewed it as something that “IT does,” meant that it would be limited in its adoption. Being a meaningful EHR user supported the organization’s overarching quality goals and they needed to put it alongside other programs that carried similar weight.

What the Change Meant
The leader of the Clinical Quality department, where the responsibility ultimately landed, admits that the transition wasn’t easy. She points out the nuances in the regulations that others had already tackled and the complexity of how each measure is ultimately met. She recognized, however, that these challenges were one that anyone would face, in any department, if someone with primary knowledge of something left the organization.

She saw this gap in knowledge that she had to overcome as an impetus to put together the same type of documentation that she had available for other quality programs. Managing regulatory programs were commonplace for her and her department, and they could bring that perspective to managing MU.

She faced the other side of the coin from what the IT trainers faced when they worked with providers to help them meet MU. While she could explain the why behind the program, and had the credibility that she’d earned through work with other programs to back it up, she found a gap in her knowledge of how to use the EHR to document an MU workflow properly. This reinforced that this was still indeed a cross-departmental program and she would still need to rely on the IT team to support her team on this part of the effort.

“We’re really used to looking at data,” she explained, when we discussed the easiest part of the program for her and her team. The parallels between the MU effort and the other government incentive programs on her plate – Accountable Care, Physician Quality Reporting System, Patient-Centered Medical Home – were so obvious that she said it would have felt like something was missing to not have ownership of the MU program alongside these.

My Thoughts
Organizations that are successful at communicating what’s important can run their MU program from any department as long as they have the support of the many departments they will rely on. That said, it is critical that in the absence of this clear message, the accountable department have experience in moving an initiative of this magnitude forward. The cross-departmental reliance means that the leader will need to have exceptional skills in both working with and influencing departments for which they are not directly responsible.

In the end, the preference of an IT-led versus a Quality-led MU program is up to the organization. Both strategies can be equally successful, but leadership must weigh several key components:

  • How has the organization historically viewed each department? Is the relationship between the practices and IT adversarial or are they partners? Do they view IT as purely technical or is there precedence in how IT has supported their workflows? This type of culture analysis is critical to understand how critical roles will support each other.
  • Is the quality department limited to data analytics and education or are they organized to be hands-on in solving issues with outlier behavior? These types of skills are essential for successful MU program management.
  • How does the Chief Medical Informatics Officer (CMIO) or Chief Medical Officer interact with each area? They will be the accountable project manager’s right hand, so this relationship is important.
  • Where should the program be in the long-term? It is tempting to be overwhelmed by the idea of moving accountability to another area of the organization, but the longer-term benefits may outweigh the shorter-term costs.
  • Where is staff turnover lower? You’ll want to place your MU program in a department that has high employee retention so there is less likelihood of significant knowledge leaving with turnover.

If you find yourself at an MU organizational crossroads, start by asking these key questions and you’ll be one step closer to a successful MU program. Read more in Part 1 and 2 of this post series.

Part 1 – Embedding MU in Daily Operations
Part 2 – IT-Led Meaningful Use Program

SA Ignite will be exhibiting at HIMSS14 in Orlando, February 23-25. Visit them in booth #1282.

About the author – Beth Houck, MBA is the Vice President of Client Services for SA Ignite. She has 17 years of healthcare analytics, operations and sales experience. She has led strategy and business development for Northwestern Memorial Healthcare and the Rehabilitation Institute of Chicago. Beth earned a B.S. in Industrial Engineering from Northwestern University and an M.B.A. from the Fuqua School of Business at Duke University.