Project Management and ARRA “Meaningful Use” Projects:
It’s Not Just for IT, Anymore!
By Chris Halvorsen, Executive Consultant

Recently, more project managers within the healthcare sector have been drawn into projects where the core constituency and set of stakeholders extends well beyond the traditional set of IT users. Implementing CPOE and advanced clinical solutions, patient and physician portals, and even shepherding contemporary hospital and health system web-sites into existence, have called upon PMs to drop the techno-jargon and soften the edges of the project management lexicon. Required PM skills now include an understanding of clinical content and the capability to articulate effectively “why” we are doing what we do rather than just “how” we are going to make a project happen. Truth is, we probably should have been better at working with the diverse set of professionals we all encounter within the provider community. But now with ARRA 2009 and Meaningful Use on the books, we just can’t limit ourselves to dealing only with very senior clinicians and clinical executives “up close and personal.” PM’s must broaden our outreach.

“Meaningful Use” commands allegiance to a standard of broader outreach. The considerations, decisions, subsequent system implementations and changes, training, submissions and integrating technologies part and parcel of meaningful use attainment with electronic health record (EHR) necessitates expanded communication. If you have occasion to say, “Hello! I’m the Project Manager of the new Meaningful Use Project,” you are more than likely meeting eye-to-eye with clinical staff who are suspicious of you and those changes to their clinical practices which they believe you represent. At the slightest doubt or misstep, they will swiftly attack your personal credentials to guide the project to fruition. While none of us should ever feel comfortable boasting we know exactly how the project will best be accomplished, some clear “lessons learned” have emerged from the shared experiences of PM’s who have been addressing Meaningful Use efforts. Six among these lessons are:

1. More than likely we should be using the term “Meaningful Use Program Director” (PD) rather than “Project Manager”(PM) to differentiate from the multiple PMs whose systems and projects will be affected by what is really an overarching initiative. This is not an activity limited in scope and attention to a single application or vendor product set.
2. The composition of the “Core Team” or “Steering Committee” utilized to delineate the set of key operative stakeholders will be comprised of more than half clinical and operational – including medical staff and “compliance” offices – and not IT technical and application management, super-users or vendor application analysts.
3. The composition of the Core Team will expand, contract and change as the program evolves through its overlapping phases and process steps from 1) regulation and “Final Rule” organizational education and impact analysis, 2) financial analysis and quantification of incentives and disincentives, 3) selection of core and menu measurement reporting options and requirements, 4) GAP analysis of current and future application functionality, 5) detailing of data integration requirements, 6) implementation of enhanced training and compliance facilitation initiatives, and 7) development, test and implementation of reporting requirements to both clinicians and governing bodies (this is not a check list of major phases!).
4. It is important for the Meaningful Use PD to be seen for both what he/she is and IS NOT! While the PD certainly must be conversant with a broad library of government regulations, rules and language, it is important that in several arenas he/she is NOT seen as the final source of information or expert determination. While the PD may shepherd the process, it is the organization executive – including the CEO, CMO, CNO, CFO and directors of compliance and health information management (and maybe legal counsel) – who must weigh in with final interpretations, decisions, training and (sometimes) enforcement measures and protocols. While PM’s from the IT section may well be called upon to employ good project management techniques, much of what needs to happen within the activity itself is decidedly not an IT effort. Knowing where to draw the line and when to sit and focus on effective process rather than contribute and debate content is a key judgment the PD must be able to exercise.
5. If the entity pursuing the Meaningful Use is a healthcare organization, then two coordinated and sometimes overlapping efforts are most likely underway – one on the ambulatory (or EP, eligible provider) side and another in the inpatient (or EH, eligible hospital) domain. While both activities may follow essentially the same process set and timeline, the personalities and decisions within each are quite unique. The PD needs to coordinate and correlate distinctly with both and not combine both parties into a confused communication mish-mash.
6. The provider cannot defer to the judgment and analysis of its systems vendor just what should be implemented to meet the requirements of Meaningful Use. While the vendor may well have a “Meaningful Use Implementation Guide”, woe unto the PD who takes that as gospel and an unerring roadmap to success. Reconciling and validating that vendor tool within the organization and unique to the specific implementation of that system within the provider must be one of the key and early areas of focus for the ecumenical project team.

While everyone comes new to this genre of PM activity, we at Vitalize Consulting Solutions have more experience than most. We have learned to staff engagements with decidedly senior healthcare professionals who possess as much experience and “time in grade” with operations as we do with traditional IT activity. Many of us have been CIO’s or COO’s within integrated health systems and long ago learned the rules of the road in dealing with senior clinicians and physicians. Being the Program Director for Meaningful Use means that I have to be at the top of my game not only regarding traditional long practiced PM skills, but also in understanding the nuances and issues of clinical workflow management, clinical quality measures and the dynamics of extracting the best and most pragmatic decisions necessary to move the project along. I need to work in such a manner that the multiple vendor PMs and site executives feel valued and accountable for the contribution of their companies to our common client. Sometimes I need to facilitate and help clarify positions between department executives who are just coming to grips with emerging government regulations and who, as yet, are unsure of exactly what they need – a feeling of profound discomfort to most! I sometimes wonder if I am not asked to be as much “sounding board” and “chaplain” as I am process sheriff and “driver” to a common end. Such roles can beleaguer an individual PM.

On the other hand, after doing project management for more than 30 years, today’s environment is stimulating, challenging and, dare I say, fun! Sometimes the ice is thin under our feet and we find ourselves at the distant edge of understanding just what it is the regulations demand. I believe that amid the seeming chaos, we’ll emerge a much stronger group with a more relevant set of applications for our clinicians and, ultimately, to the betterment of care for our patients. Those PD disciplines I follow are no longer just for the betterment and success of an IT project, they are for everyone involved.

To learn more about VCS’s Project Management Office solutions, call 610.444.1233, email vcs@getvitalized.com, or visit www.getvitalized.com.