How to build a POCUS program.
Setting up a POCUS program can feel daunting. There are many moving parts to keep track of. Here are some important steps to consider. Having an experienced POCUS expert or POCUS team who can dedicated time and energy to this endeavor is essential for the success of the program.
Check for existing POCUS policies at your institution. What are the requirements to get POCUS privileges and what is the credentialing process?
If your institution does not have POCUS policies, you will need to create them by following guidelines from national organizations (i.e., AIUM) and your specialty-specific organizations (i.e., ACEP for emergency medicine). It is prudent to form a POCUS committee and involve all the key players (radiology, emergency medicine, etc.) to agree on a POCUS policy for your institution.
Once you have determined the scope of POCUS practice and the credentialing requirements for your department, you will need to make sure everything is in place for the providers to start scanning and documenting their scans. This includes:
a. Ultrasound machines in dedicated locations that are well maintained and connected to secure WiFi
b. Usually, a middleware to archive the exams and to perform quality assurance
c. Biomed and IT departments who are supportive of the effort and are ready to deal with any machine, software, or WiFi issues
d. Timely quality assurance process to give your providers feedback on their scans
Once the above is established, you are ready to credential your providers by keeping track of the number and quality of their scans. Note, for beginner sonographers, you will either have to put on a workshop or send them to a POCUS course before they start performing scans on the patients.
After your providers are credentialed in POCUS, they can request privileges to perform “diagnostic” POCUS. This means they can perform POCUS on patients and make clinical decisions based on their findings. The providers will need to perform an additional step at this point, that is document POCUS findings in the EMR. It is wise to work with EMR IT to design POCUS procedure notes, or even better, to directly transmit the filled-out POCUS worksheet in the middleware into the EMR.
Billing for POCUS becomes an option once the providers are credentialed and have privileges to perform POCUS at your institution. For this to occur the exams must be indefinitely archived, an appropriate procedure note must be entered in the EMR, and the coders must know that they can now bill for POCUS. Involving your coders and billers is an essential step. Robust POCUS programs can generate enough revenue to not only cover the expenses of machine and software purchase and compensation for POCUS expert, but also to generate additional profit to support other improvements to your practice. More on the profitability of POCUS in a future post!