Penn Medicine at the University of Pennsylvania
By implementing the Echo Provider Assessment Portal, Penn Medicine was able to:
- Move from time-consuming paper process to more efficient automated electronic credential review
- Streamline the interaction between the Medical Staff Office and all credential reviewers
- Develop a verification/red flag checklist to enable the uniform evaluation of providers across the health system
- Align differing department processes for credential review into a single organization-wide process
- Strengthen interdepartmental relationships by including many stakeholders in establishing a workable process
Penn Medicine at the University of Pennsylvania, the nation’s first hospital, incorporates six facilities with over 4,000 credentialed providers. The Medical Staff Office (MSO) for Penn Medicine utilizes Echo as the source of truth for all provider information related to credentialing and health plan enrollment. In 2012 the Penn Medicine MSO made a strategic decision to streamline and automate their processes. The credentialing review process—where an initial applicant or reappointment applicant is reviewed by the clinical department chairmen prior to presentation to the Credentials Committee—was an important part of that effort. The focus was on opportunities to deploy an electronic process to eliminate inefficiencies in the series of interactions between the MSO and the reviewers which were required to complete the credentials review process.
If all that wasn’t enough, Penn Medicine also uncovered inefficiencies in the time between when a review was sent from the Medical Staff Office, to the time it was completed by all Reviewers. While the bylaws had always stipulated the maximum time-frame acceptable to complete the credentials review process, there was no resource or methodology available to determine how long each of the review steps actually took. They were looking for an electronic process which would provide the tools to document the time required for each step and to identify opportunities to shorten and streamline the entire process.
The solution Penn Medicine selected was the Echo Provider Assessment Portal. It delivered exactly the electronic tools needed to enable Reviewers to review and sign off on standardized credentials packet, an extract of the complete file, using a streamlined process.
To build internal ownership for this solution, Penn MSO leaders met with key physician Reviewers, including department chairs and credentials committee members. The physicians they approached were technologically savvy and interested in electronic tools, frequently serving on other Penn Medicine technology committees and task forces. Penn leaders sought the advocacy of these key physicians and listened carefully to understand their needs, requirements, and perspectives. Many of these key physicians became an integral part of the team who deployed the Provider Assessment Portal. They provided valuable insight from the reviewer’s perspective.
To deploy the Provider Assessment Portal, Penn Medicine conducted an evaluation of the documentation required for a successful review of a verified credentials application. In order to develop a paperless review process, all parts included in the packet needed to be electronic. That meant scanning of documents received during the verification process.
Historically, all Penn Medicine credentials packets had been the aggregation of every component collected during the application and verification processes; with all the documents ordered in a generally consistent manner. With the guidance of the physician champions, each element of the file was reviewed for appropriateness with a keen eye toward what could be prioritized.
As a result of the evaluation, a Scanning Protocol Guide was developed. The guide identifies all documents to be scanned into Echo; the location in Echo for that type of document; the record Type in Echo (such as Medical School); the individual responsible for the scanning; the process the document is used to support; and any tips to make it easy for MSO users. The Scanning Protocol Guide is regularly updated so it is current and readily available to all Echo users as a reference. It is accessible to them both on a shared drive and as a link in Echo.
Streamlining the process required a method to flag components to be brought to the attention of the Reviewer. In the paper method, sticky tabs were used. As a result of the evaluation, a Verification/Red Flag Checklist was developed in conjunction with the Credentials Committees and Medical Executive Committees. This ensured that vital information was incorporated into the electronic packet and flagged when necessary.
Penn Medicine found there was a lack of uniformity in the previous, manual red flag review process. A positive benefit of this project meant that moving forward Penn Medicine Reviewers would be evaluating providers uniformly across the health system. It also clarified what was important for the MSO to provide to them as red flags. For example, the Reviewers always wanted to see reference verifications because they were able to “read between the lines” to glean additional insight from the responses.
Following is a summary of the content in the Verification/Red Flag Checklist:
The resulting file extract was less voluminous and issues are now identified for the Reviewers in a consistent manner. For example, each Penn Medicine credentials packet now includes the following components:
Section 1: General demographic information about the applicant
Section 2: A grid summarizing verification of the licenses, DEA, current malpractice and other basic credentials (note: these were not deemed to require display of scanned images)
Section 3: Scanned images of all reference forms
Section 4: All red flag information including but not limited to the complete text of the NPDB report
Section 5: The privileges requested and those not requested by the applicant
In advance of Go Live, the MSO began rolling out elements of the review process. This included the redesigned, standardized credentials packet as described.
By deploying the proposed electronic packet first in a paper form and then later electronically, the Reviewers became comfortable and confident in the information they were receiving. They were able to discuss, agree upon, and request packet modifications; see the red flag rules in a real situation and modify as needed; and understand how the scanned documents would be incorporated in the more familiar paper format. Later when presented with electronic versions of the same key information, they were comfortable with the shift to the electronic format. When the electronic portal was activated, the information included within the updated packet was validated as the new standard of practice moving forward.
Training programs were developed for the Medical Staff Office users, the MSO support users, the physician and staff Reviewers, and IT professionals. The training program for the MSO users and support users involved teaching them the situations which could be presented by Reviewers and helping them to understand the best approach to troubleshooting or answering questions. For example, if a Reviewer contacts the MSO because they aren’t seeing the provider in the portal they need to review the training scenarios which provide a troubleshooting guide on how to resolve.
When a Reviewer completed a review for the first time a meeting was scheduled which included an IT professional, a Medical Staff Office user or support user, the Reviewer and a member of the Reviewer’s administrative staff. The MSO collaborated with the Reviewer to provide a detailed explanation for how each step of the process is completed. IT continued to be available to remove any technological barriers that might prevent the review from being completed. As a result of this hands-on training, the MSO was able to strengthen relationships between Reviewers and department leaders. Another benefit was that the Medical Staff Office team became both more technology savvy and more confident in their skills.