
HealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
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View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsFulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.
View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
View All ProductsHealthStream's education helps address diversity, equity, and inclusion within your organization, as well as promoting health equity in the communities you serve.
View All ProductsDeliver custom or industry designed product training directly to patient and resident care environments to reinforce proper use.
View All ProductsTeach your healthcare staff about the revenue cycle and claim management through targeted training and video tools from HealthStream.
View All ProductsIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsHealthStream's EMS Program offers a comprehensive, CAPCE accredited EMS course library that meets National Registry annual recertification.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
View All ProductsExperience standardized and centralized healthcare credentialing, privileging, and enrollment that is smarter and faster than ever before.
View All ProductsAutomated, web-based provider credentialing and enrollment software for growing medical groups.
View All ProductsNCQA-certified CVO verification services for initial and re-credentialing files in an overflow or full-service capacity for healthcare organizations.
View All ProductsSearch, review, and add providers into the Epic provider master file with our Epic app integration, Provider Validate.
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View All ProductsHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
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View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
View All ProductsMitigate risk and elevate your quality of care. Improving both clinical and business outcomes starts with a smarter, more integrated approach to regulatory training, continuing education and quality management.
Learn MoreIn the history of the impact of conflicts of interest (COI) in healthcare, the rise and fall of arthritis pain drug Vioxx was a watershed event. All the elements were there: a major drug company study, incomplete reporting of data by drug company employees, data oversight by someone with at least the appearance of a financial COI, and a failure to disclose adverse effects of the drug. Even the FDA bore some responsibility.
The resulting scandal damaged the reputation of the New England Journal of Medicine and Merck, an admired pharmaceutical company. Vioxx cost Merck over $5 billion in settlements.
An FDA whistleblower stated that 60,000 people died from heart attacks in the five years before Merck voluntarily withdrew the drug in late 2004. COI—even the appearance of COI—has the potential to seriously harm patients and damage healthcare institutions.
Not All COIs Result in Biased Decision-Making
COI exists when a person could derive personal benefit from actions or decisions made in his or her official capacity, but do all COIs require redress? According to Bill Sacks, co-founder of HCCS, “Relationships among physicians, hospitals and the medical industry are important. Industry contributes to medical education, funds clinical trials, and provides medications for the indigent. In short, they support the teaching, research and clinical missions of academic medicine.”
Typically, only 8 – 12 percent of disclosures require review by the compliance department or an internal COI committee, and only 1 – 2 percent may need recusal from decision-making or divestiture of stock. A potential COI disclosure risk, therefore, is the possibility of “throwing the baby out with the bathwater.” On the other hand, failure to adequately address COI exposes institutions and patients to risk.
Managing COI Risk
Regulatory compliance requires that healthcare organizations secure annual conflict of interest disclosures from physicians, APPs, board members, and hospital leaders at the director level and above. Effective disclosure requires a thorough questionnaire to guide discernment of any conflicts. The questionnaire must walk individuals through their business relationships, revealing the potential for COI. Conflicts must then be reported on a disclosure form.
Perhaps a physician is influencing the purchase of a medical device. Is the doctor’s recommendation the best possible choice, or is it because he receives speaking fees from the device manufacturer? Are stents selected by a hospital the best choice for patients, or was the purchase influenced by the cath lab director’s relationship with the sales representative? A hospital board member is the sister of a bank’s CEO. Did this relationship influence the selection of the bank as a lender?
Unknown and undisclosed conflicts can threaten an institution’s tax-exempt status, reputation, research funding, and most importantly, patient safety.
When a Disclosure Requires Action
COI Policies should define the types of disclosures that require a management and mitigation plan. The plan should prescribe the steps the organization will take to mitigate any bias or appearance of bias. The institution could ask the individual with a conflict to reduce the value of a financial relationship so that it falls below a threshold amount designated by policy. The individual could be required to forgo participation in committee votes, deliberations, or decisions about a topic related to that individual’s conflict of interest.
For research projects, it may make sense to modify the design of the project or have an independent researcher serve as the principal investigator. Another approach could be to provide an observer to monitor and evaluate any appearance of bias in the decisions made or influenced by the individual.
Managing and Monitoring Disclosures
The compliance director or the compliance committee must review and vet annual COI disclosures. An automated system, with an online COI questionnaire, simplifies this process significantly and reduces the possibility of overlooking important disclosures. Paper and pencil disclosure forms are more difficult to manage within policy expectations and are more difficult to secure for confidentiality.
Proper vetting looks at a variety of risks, especially any possible influence on medical judgment. The process must include evaluating whether any compensation is for bona fide work and whether it reflects fair market value. Appropriate review will reveal whether referrals were expected because of any gift or compensation. Implementing an organized—and automated—process prevents surprises by proactively managing any questionable relationships.
If your organization is looking for an automated, single-platform solution for managing COI, visit hccs.com/COI for information about COI-SMART, a cloud-based platform offering custom questionnaire design, best practice advice, management plan templates, and relevant subject matter.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceFulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.
View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
View All ProductsHealthStream's education helps address diversity, equity, and inclusion within your organization, as well as promoting health equity in the communities you serve.
View All ProductsHealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.
View All ReimbursementTeach your healthcare staff about the revenue cycle and claim management through targeted training and video tools from HealthStream.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ResuscitationIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsHealthStream's EMS Program offers a comprehensive, CAPCE accredited EMS course library that meets National Registry annual recertification.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
View All ProductsLearn more about HealthStream's Provider Credentialing, privileging, & enrollment solutions.
View All CredentialingExperience standardized and centralized healthcare credentialing, privileging, and enrollment that is smarter and faster than ever before.
View All ProductsAutomated, web-based provider credentialing and enrollment software for growing medical groups.
View All ProductsNCQA-certified CVO verification services for initial and re-credentialing files in an overflow or full-service capacity for healthcare organizations.
View All ProductsSearch, review, and add providers into the Epic provider master file with our Epic app integration, Provider Validate.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
View All ProductsPrecisely align staffing and needed resources to enable efficient patient flow and high-quality, cost-effective patient care.
View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
View All Products