IntelliSoft Group Blog

by Mike Melville

There will be $1 Billion is stimulus grants going toward funding broadband connectivity to underserved communities according to the Obama Administration.  The good news for us and others in healthcare IT businesses is some of this money will directly impact over 900 health care facilities.

Since many of these underserved areas are rural with small healthcare facilities better access to broadband will now allow these institutions to access cutting edge software programs in a software as a service (SaaS) or Cloud environment.  Access to radiologist and other specialist thousand of miles away will now be available over the internet.  Even key support systems like credentialing, provider enrollment, and quality & risk management can be easily and cost effectively utilized with a high speed internet connection.

Since there is little money at these locations to fund capital purchases of software, access to systems via high speed internet allows them to utilize many systems only available to larger facilities or those in more urban areas.  This also eliminates the need for costly IT support since programs accessed in a SaaS or Cloud environment are completely supported by the vendors IT staff.

This expansion of broadband will help increase access to cutting edge software tools inevitably having a positive effect on quality of care.  Read the rest of this entry ?

By John Eddy

     Shawne Wickham’s August 22^nd article in the New Hampshire Union Leader identified the importance of credentialing for nurses in the home care setting.    Ginger Chiapetta a nurse with a history of substance abuse and disciplinary actions in Vermont, was able to renew her New Hampshire license by concealing the Vermont restrictions.  Furthermore, she was able to secure employment with Armistead Care Giver Services despite having  Board-imposed license restrictions.  Chiapetta was restricted from administering pain medication and could not practice in a home care setting after 11:30pm.

Police were called in to investigate a report of missing medications from a patient’s home, and soon discovered that Chiapetta, who had recently signed the patient’s death certificate, had administered pain medication.  Although she was prosecuted, the District Court Judge found Chiapetta innocent of all charges on the grounds that the case should be handled administratively and not criminally.

Simply put, if Armistead had checked with the license board, Chiapetta’s restrictions would have been easily discovered.  The firm now apparently cross-checks all licenses for their caregivers.

By Marty Takessian

From a purely data-centric perspective, Medical Staff Organizations and Healthcare Quality Assurance Teams are increasingly being asked to work together in order to create a more comprehensive and noteworthy data-profile of Providers.  Unlike most of us, Providers are presented with unique challenges each day.  Each patient and every case presents individual challenges of diagnosis that can include an unlimited amount of complications.  With each passing moment, new data is generated for a patient’s perspective as well as from a practitioner’s perspective.

How can hospital’s gather and create an overall comprehensive view of providers’ competency and performance while also consolidating information into a profile that can be used subjectively to compare success attributes of specialists?

Does there need to be systems that draw standardized OPPE and FPPE attributes for generalized Quality Assurance data pulled from Hospital Information Systems?    Does this data need to present near-real time reporting and comparisons or world once a month or once a quarter reporting suffice?

As Medical Staff Organizations and Quality Assurance Teams begin to understand each others’ responsibilities and realms, new models of information management will form.  New and more integrated software capabilities will be developed by the vendor community to not only gather, sort, segment, and analyze the information, but to also help consumers of that information visualize, analyze, report and act upon perceived results.  It is not too far-fetched for us to imagine that several groups of healthcare professionals may want to visualize and interpret the same data in multiple ways.

How much and what type of competency and performance indicators are viable as a component of an initial appointment or a reappointment record? 

Of course, any amassment of large volumes of data need to be done carefully and according to a pre-established plan.  Data, no matter how “clean” or comprehensive needs to be structured carefully and interpreted consistently.  Interpretations and corresponding results need to be checked against actual results in order to build and maintain credibility.

The next installments of Credential Data Management blog series will be:

• Who is gathering and interpreting this data/information and why?
• Data Migration vs. Conversion;  What it means and what’s the difference?
• Challenges of system compatibility and data integration
• 5 Gotchas to Lookout for when Credentialing and Quality Data are “on the move”
• How much data is in a Provider’s Credentialing Profile?

By John Eddy

     Increasingly, I am having conversations with the credentialing community in which a recurring theme emerges – Medical Staff Offices are becoming the data hub for all provider related data.  This means the role of the Medical staff professional has expanded.  The primary role, or at least most intense role, was credentialing at one time (i.e. primary source verification).  Tracking privileges was also a core function to varying degrees.

Those days are gone.  A series of serious challenges come along with the rise of prominence of the Medical Staff Office. The staff is now asked to be the aggregation point for almost all provider data and support the organization with reporting.  The staff seems to answer to a lot more masters and support many departments.   The staff must still manage the provider credentialing cycle and privileges at a granular level.  However, the Medical Staff Office must now also track OPPE/FPPE, correlate quality data, track ongoing education, measure billing efficiency, and manage credentials for payer enrollment.

They must do this in the context of ever-increasing complexity to healthcare delivery systems.  Group practices of all forms join the system as well as a number of affiliated entities.

Consolidation of healthcare delivery systems and managed care also weighs heavy on an influx of provider data to manage.  Cheryl Clark of HealthLeaders Media (March 26, 2010) points to the fact that rapid consolidation in managed care and commercial health insurers is giving them considerable leverage. The payers are raising the bar on credentials and quality records of providers.  The payers are effectively asking for more data.  The Medical Staff Office must now play a prominent role in supporting fiscal management initiatives – i.e. they help their organization get reimbursed by supporting payer enrolment initiatives.

Furthermore, ARRA legislative impact will inevitably create a surge in provider data requirements.  The US Census Bureau estimates that there are over 46 million uninsured Americans.  Theoretically, these Americans will have access to healthcare over the next few years (the law sets the target date at 2014).  Who will treat these people and who is going to credential the providers treating them? Secondly, the intent of the legislation is to improve the overall quality of providers delivering healthcare in the US.  The legislation makes an attempt to tie reimbursement to quality.  This too will require more provider data to manage.

So it seems, the Medical Staff Office is rising in prominence.  Added objectives and responsibilities will require automation needed to aggregate a vast amount of data collected throughout their organization on a number of systems. Essentially, the Medical Staff Office will become the data architects for all provider related information.  They will also need to construct and develop reporting process to keep all the relevant departments and executives informed.  Oh, and yes they will need to continue managing the traditional credentialing process as well.

By John Eddy

     Will credentialing systems join the EMR ecosystem?  Clearly industry pundits and a lot of emerging companies are placing bets on the maturity and viability of EMR technologies.  Credentialing systems, however, have typically been deployed on the fringes or outside of EMR systems.  Effectively, there seems to be an electronic barrier between patient and complete provider data.

This is an almost paradoxical division.  Improvements in healthcare communications (aka EMR) are designed to automate the patient, provider, healthcare facility and payer relationship while improving the overall quality of care.  It seems though that a key component, a provider’s credentials and profile, is missing from the EMR methodology when it should probably be a core component.  A provider profile is a key ingredient to maintaining patient safety and positive outcomes and directly impacts how fiscally efficient the payer-facility relationship is.

This gap may be attributed to organizational best practices, but the credentialing software community has not stepped up efforts to look at ways their systems can plug into the EMR ecosystem.  So, healthcare organizations do not have a lot of choice.  This represents a good opportunity for both healthcare delivery systems and credentialing software developers to begin the process of automating and integrating the provider profile in to EMR systems – and vice versa.  Hopefully, the credentialing software developers will take this opportunity to heart and begin developing EMR ready solutions quickly.