Privileges

Strategies for Deploying and Disseminating

Presented by

Andrew M. Allemao

Keys to Effective and Efficient Privileging

Move from laundry list to Core Privileges

Use technology to decrease the manual process for disseminating privileges

Suggestion 1:

Migrate to Core Privileges

What’s Wrong with Laundry Lists?

Wastes physician’s and reviewer’s time

Requires physicians to request every single procedure they may be qualified to perform

The reviewer must evaluate qualification and clinical competence on EACH line item

What’s Wrong with Laundry Lists?

New procedures and conditions require staff to continually update the list

Privilege lists become obsolete

Writing "other" at the bottom of the privilege request form invites physicians to apply for privileges for which the hospital has no predefined criteria

What’s Wrong with Laundry Lists?

Potential legal/regulatory exposure:

Many line items have no predefined evaluation criteria

High potential for human error in every step of the process:

Request Review Nursing Station/Surgery Scheduling

“If a physician fails to check a particular procedure on the list and performs that procedure anyway, is your institution liable for a charge of corporate negligence?”

Ask Yourself…

Ask Yourself…

“Does your institution critically review each applicant's prior education, training, and experience in every clinical area marked on the applicant's form, even when the request comprises over 60 check marks?”

Core Privileging

The cure for the common privilege process

Anatomy of Core Privileges

Predefined criteria for each privilege must outline requirements regarding:

Education

Training

Experience

Anatomy of Core Privileges

Descriptions of privileges and requirements must be:

Accurate

Detailed

Comprehensive

Specific

Core Privileges vs. Lists

Less burdensome for the doctor to request

Less time consuming to review

Less prone to Type I JCAHO recommendations

Less likely to have to deny privileges as criteria for holding privileges are well defined

Which would you rather maintain?

Core

Laundry List

So Why Don’t More Hospitals Adopt Core?

Defining comprehensive requirements for each privilege category requires a lot of time on the part of department chairs and Credentials Committee members

Laundry lists basically work

General bureaucratic resistance to change

Suggestion 2:

Use technology to create a less manual process for

disseminating privileges

Options for Disseminating

Manual Distribution

Electronic Distribution MSLW installed at all workstations

MSLW or ECHO with Web Portal

Manual Dissemination

Most Common – Least Efficient

Process for Manual Distribution

Start

Privileges

Approved

Make Copy for

Each Nursing

Station

DeliverCollate for

DistributionNursing Station

Updates Book

End

Update System and

File

Manual Distribution - Concerns

Not real timePages might not get deliveredPages might not make it into the bookHigh human resource costHigh raw materials consumption

Paper Toner Binders

Electronic Dissemination

The cornerstone of electronic distribution of privileges is getting the privileges tied to providers in MSLW/ECHO

Options for Getting Privileges into MSLW or Echo

1. Attach scanned image of the approved privilege form to each provider record

2. Have privilege templates in MSLW or ECHO and enter the approved responses

Process for Scanning

Scan Save

Attach

Requirements for Scanning

Scanner

Hard drive space for the images

Scanned multi-page images must be saved as TIFF images

Client workstations must be able to read TIFF images

Scanned Images: Pros and Cons

Pros

Conceptually easy

Real time

Password protected

Printable

Cons

Not searchable

Volume necessitates high-end scanner

Need software to convert image to TIFF

File saving can be complex

Options for Getting Privileges into MSLW or Echo

1. Attach scanned image of the approved privilege form to each provider record

2. Have privilege templates in MSLW or ECHO and enter the approved responses

Privilege Items in the Software

Line Items in the Software: Pros/Cons

ProsQuery to find who can perform specific proceduresReal timeEasy to updateNo special knowledge required to do data entry

Cons

Up front work to set up privileges time consuming

MSLW on Every WorkstationA good way to spread the word

MSLW on Every Workstation: Pros/Cons

Pros

Password protected access to privileges

Real time

No binder update

No copying

Fewer “weak links”

Cons

User must learn enough about MSLW to select a physician and view privileges

IT support required to install/support MSLW on each workstation

MSLW or ECHO + IntranetThe best way to spread the word

Intranet Solution for Privileges

Medical Staff

Office

Data Server IIS Server

IntranetIntranet

NU1

OR

NU4

NU3

NU2

Surgery Scheduling

Steps to Implementing Net Solution

Enter the privileges into the credentialing product

License the MSLNET or ECHO Portal

Prepare web server

Ensure all intended users have web connection

Define who needs to see what information

Design the desired page layouts

Work with HLS to build the template pages

Net Solution: Pros and Cons

Pros

Real time

Reduced possibility of JCAHO Type I

No need for photocopies

Easier for NU’s

Screens designed by the MSO

Cons• License required• IT required for initial

set up

Efficiency Comparison - Ongoing

Efficiency

Manual MSLW/ECHO MSLW/ECHO

+ Net

Hours/Year – Ongoing Dissemination

0

10

20

30

40

50

60

70

80

Manual MSLW /ECHO

Prod +Net

IT SupportTrainingCopy/Distribute

Summary

By adopting core privileging and using technology to help disseminate, you can turn a chaotic, error prone process into an efficient and effective one.