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…

“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 Deliver Collate for Distribution Nursing Station Updates Book End Update System and File

Manual Distribution - Concerns Not real time Pages might not get delivered Pages might not make it into the book High human resource cost High 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 Pros Query to find who can perform specific procedures Real time Easy to update No special knowledge required to do data entry Cons Up front work to set up privileges time consuming

MSLW on Every Workstation A 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 + Intranet The best way to spread the word

Intranet Solution for Privileges Medical Staff Office Data ServerIIS Server Intranet 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 ManualMSLW/ECHO + Net

Hours/Year – Ongoing Dissemination

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.