DATA GATHERING GONE WILD !! ENOUGH ALREADY !!!!

Once upon a time a physician would be granted emergency credentials on very short notice if requested, or needed by the hospital or a member of the medical staff. A quick call to the chief of staff or medical director followed by a call to the institution in which the visiting doctor was already credentialled was all that was necessary.

A  recent post on Medscape eschews what has happened to the world of credentialling.  Why ? About two decades ago there were many occurences of imposter physicians, and/or physicians who were sanctioned, or whose priveleges are suspended or revoked. Many of these physicians would move to other jurisdictions to practice without knowledge of their history.  The crevasses and crannies have been sealed.

Andrew N. Wilner, MD, a neurologist who performs locum tenens at hospitals who would otherwise not provide his sevices. He reports what many physician experience when attempting to work at different hospitals. 

The medical credentialling process has run amok !. The process itself is not overwhelming, however it may involve letters or corroboration from many hospitals and colleagues who are already overwhelmed with bureaucracy.Some of the information may be decades old. Medical staff offices and licensing bodies often take a month or more to find a request before acting upon them.

Hospitals and credentialling committees are suspicious about established  physicians applyng for medical staff priveleges. When questioned why the intense historical day to day emplyment, vacations, and other time slots, I have heard a number of explanations. Such as time in prison for fraud and abuse, DUIs, that may have been ignored, or psychotic episodes, which applicants would be hesitant to disclose. Often the commission of a felony would eliminate the issuance of a new medical license, and a record of a psychotic episode would result in not granting privileges, even if the physician was treated successfuly or had served prison time with good behavior.

Interminable Delays

Delays in credentialing, often adding up to months, deprive patients of clinical care and physicians of the ability to earn a living. (Ask a few random physicians how long it took to get their hospital privileges, and watch them roll their eyes.)

For example, I recently requested an application for privileges from a hospital that shall remain unnamed. Despite numerous requests on my part, it has been more than 2 months, and I have not yet received the application. (The actual hospital privileges will take months after submitting the as yet unavailable application.) The hospital's response? They simply don't have the "resources" to put the form in the mail. They are too busy processing other applications to mail out new applications!*

In another case, the number of requests by a hospital for "additional information" was so numerous and protracted that by the time the application was complete, the institution had been sold to another hospital system, which had a different application. So the process had to be started all over again.

In yet another case, I was unable to begin a locum job (in a state where I was already licensed) because the hospital could not grant privileges with nearly a 2-month lead time! I lost a work opportunity, and I don't know whether the hospital ever got coverage for their patients.

Loss of Privacy

In our medical system, we agonize over every tidbit of a patient's privacy, even mandating secure email and fax systems that comply with the Health Insurance Portability and Accountability Act (HIPAA). However, the opposite is true regarding those who work in that system: Nearly every facet of a physician's life is exposed in these applications. The boilerplate disclosure states that these details can be shared with all necessary parties—which, if you read the fine print, includes almost everyone in the civilized world.  The application process rivals that of applying for a security clearance when applying for a VA or military medical position 

Conclusions

The current requirement for each and every hospital to individually credential their medical staff is time- and resource-consuming, and possibly the most inefficient way to achieve the purported goal of protecting the public. Certainly, physicians and other medical personnel should be vetted. However, physicians with active medical licenses should not be forced to provide countless professional and personal details to hospitals about their lives (details that in most cases have already been provided to state licensing authorities or other hospitals), and then be subjected to months of unproductive waiting until they can begin work.

Unlike many of the imperfections in our healthcare system, this one is easy to fix. Credentialing should be centralized, as it is in the military and veterans systems, so that it need be done only once. The same applies for state medical licenses; one federal medical license would suffice. Rather than cost money, this fix would save a bundle. Currently, there is an effort by the Federation of State Medical Boards to set up a system that would simplify applying for multiple state licenses, but it still needs approval by state legislatures before it goes into effect.

What Do You Think?

1. Does anyone else have the impression that the questions on hospital credentialing applications go beyond common sense?

2. Should the date of one's high school graduation be included in hospital privilege applications?

3. Is there a hope for a centralized hospital credentialing service that could save time and money, and expedite getting doctors to work?

Let us know your thoughts in the comments section.

Big Data and Mapping

Data mapping is more easily presented and understood more than conventional tables. The Federal and State public health agencies now  present public health statistics, demographics and disease prevalence in a map format. Data maps are the result of converting fields and tables into a graphic presentation in different formats. Bar graphs, Pie graphs, and more presentations such as shaded areas on maps indicating higher and/or lower incidences of disease, population demographics, and

Most physicians are familiar with these formats, however there are sources to educate professionals how to interpret data by Mapping.

GIS, or Graphic Information Software is readily available from many sources. 

 Quantum GIS

 gvSIG – gvSIG

 GRASS GIS

 MapWindow GIS

 ESRI ArcGIS – ArcGIS

 Additional GIS products

  GIS is a visiual tool essential for population health studies, and may also be applied to outcome studies   by region,or health plans

The Failings Of Meaningful Use

It is remarkable that a program aimed at specific end users continues despite the fact the majority of those end users refuse to comply, even despite financial penalties from CMS.

By Linda M. Girgis, MD, FAAFP

Stage 3 M..U.

The intent of the meaningful use (MU) program, signed into law as the HITECH Act in 2009, was commendable, but its implementation has been wrought with delays and failures. While many doctors successfully attested for Stage 1, SERMO – an online community exclusive to physicians – is reporting 55 percent of the 2,000 doctors it recently polled said they will not be attesting for Stage 2 this year.

The Failings Of Meaningful Use

Many in healthcare question the sustainability of this program. While its noble goals are recognized, it has had a detrimental effect on doctors in private and small practices with both the cost and time required to implement it simply too much. Even hospitals and large systems struggle to realign their infrastructures to comply.

These failings are trickling down to patients resulting in less than desirable outcomes. Many doctors are choosing to drop Medicare rather than be penalized for something they don’t agree with. What I see as the biggest failure of MU, however, is the fact that its implementation was enforced before its feasibility addressed. How can MU succeed when the majority of doctors reject it?

In my practice our proposed interfaces failed to materialize because our vendors could not work with each other and rather than fix the problem, they pointed fingers at each other and tried to sell us their product. For example, it took 18 months to get our patient portal active and that only happened after we changed web hosts. Despite this, we are still not interfaced with our local hospitals and their vendors solution was for us to purchase the hospitals’ software. This, however, is not an option as we are affiliated with three hospitals which do not use the same system.

The adverse effect on providers as a result of implementing the technology MU requires is yet another reason the program is failing. For instance, many EHR systems do not do what is required to meet the standards. The software at my practice is in constant need of upgrades and new buttons to mark being added frequently. The metrics required to attest are stringent and not all systems are capable providing them.

The failures of the MU program are myriad, and not just on a small scale. It deselects, by its intrinsic workability, doctors in small and private practices. It cannot continue without fixing the inherit failures in the ability to carry out the requirements.  For me, I am attesting for Stage 2 because I have been using EHRs for 10 years and believe there is great value in digital data. However, I hope the technology and implementation catch up to the spirit of what it was intended to achieve.

The Failings Of Meaningful Use

It is remarkable that a program aimed at specific end users continues despite the fact the majority of those end users refuse to comply, even despite financial penalties from CMS.

By Linda M. Girgis, MD, FAAFP

"The intent of the meaningful use (MU) program, signed into law as the HITECH Act in 2009, was commendable, but its implementation has been wrought with delays and failures. While many doctors successfully attested for Stage 1, SERMO – an online community exclusive to physicians – is reporting 55 percent of the 2,000 doctors it recently polled said they will not be attesting for Stage 2 this year."

Meaningful use was proposed by HHS at the beginning of the HIT initiative.  It has nothing to do with the  meaningful uses of EHRs.  Meaningful use has to do with the use of the  data by second parties, mostly HHS and CMS.  Designed initially to be implemented in three stages, the first two have been implemented already. Those who did not or could not comply by October 2015 now face a penalty and reduction in payments from CMS (Medicare).  Stage I was not too difficult, Stage II was more onerous, and most of those who did not attest to Stage II  have indicated they will not attest to Stage III .  Many of these requirements are expensive and require extensive software patches or complete replacement of functional EHRs that have not passed their usable lifetime, nor earned their full deductibility according to IRS tax codes.  In fact many medical practices no longer host their own EHR and now lease cloud based EHR applications, where the upgrade is accomplished by the EHR host.  In fact this open up the possibility of cyber-threats.  The same may be said of Health Data Exchanges.

Many in healthcare question the sustainability of this program. While its noble goals are recognized, it has had a detrimental effect on doctors in private and small practices with both the cost and time required to implement it simply too much. Even hospitals and large systems struggle to realign their infrastructures to comply.

These failings are trickling down to patients resulting in less than desirable outcomes. Many doctors are choosing to drop Medicare rather than be penalized for something they don’t agree with. What I see as the biggest failure of MU, however, is the fact that its implementation was enforced before its feasibility addressed. How can MU succeed when the majority of doctors reject it?

Another failure of MU is it doesn’t properly address interoperability. One of the goals of the program was to have systems which communicate with each other, but this simply has not happened on a large enough scale. And it never will as there are too many systems and vendors who do not want to work with each other to build interfaces, they want to sell their own products.

In my practice our proposed interfaces failed to materialize because our vendors could not work with each other and rather than fix the problem, they pointed fingers at each other and tried to sell us their product. For example, it took 18 months to get our patient portal active and that only happened after we changed web hosts. Despite this, we are still not interfaced with our local hospitals and their vendors solution was for us to purchase the hospitals’ software. This, however, is not an option as we are affiliated with three hospitals which do not use the same system.

Many blame EHRs for slowing providers down and taking time away from the patient. However, it is not the EHR doing this but rather the metric reporting which is now required. Much of this reporting has nothing to do with patient care or a particular visit. For example, we are asked to record our patients email addresses and some don’t want to share this information. There is no option for this and, as a result, is picked up as a failure on our part. Is an email address really meaningful to a patient’s medical care?

The failures of the MU program are myriad, and not just on a small scale. It deselects, by its intrinsic workability, doctors in small and private practices. It cannot continue without fixing the inherit failures in the ability to carry out the requirements.  For me, I am attesting for Stage 2 because I have been using EHRs for 10 years and believe there is great value in digital data. However, I hope the technology and implementation catch up to the spirit of what it was intended to achieve.

About The Author
Linda Girgis, MD, FAAFP, is a board certified family doctor with Girgis Family Practice. Dr. Girgis studied medicine at St. George's University School of Medicine and served her residency at Sacred Heart Hospital in Allentown, PA.