HIMSS23: Refining peer review

Courtesy of HIMSS | © Lotus Eyes Photography

Peer reviews are required by CMS and the Joint Commission to evaluate and monitor practice of individuals that hold privileges at a health facility, but the process can often be convoluted and not doctor-friendly. Streamlining the process by moving to a digital process is a great way to free up doctor time and make them more engaged in the process, according to a panel from Cone Health, which presented on the topic at HIMSS23 in Chicago.

Too often, the process is seen as punitive instead of educational and pushed acceptable practices instead of best practices. The team at Cone Health, which included presenters Donna Albright, RN, Elisa Haynes, RN, both medical staff quality coordinators, and Michelle Reece, RN, manager of medical staff quality, set out to change this.

In 2022, the team reviewed over 3,000 cases were reviewed by Cone, and a more efficient method was needed, even though providers were comfortable with it. Physicians were not engaged and were often working on the cases during the review meetings, paperwork was being lost, the review team was delivering paperwork to multiple facilities, and doctor handwriting was often ineligible. All these issues contributed to a delay in feedback of physicians being reviewed.

They established a lean process that involved the physicians and advanced practice providers in the process so everyone understood the changes. They started with a small pilot program of four physicians to engage with the smaller group and sort out problems before it rolled out to the entire staff. When the system rolled out, they set a goal of 82% completion rate, and by the fourth quarter, they hit 85%, even though COVID hit during the process.

After the transition, cases are now reviewed prior to meetings, committee chairs are prepared, and concerns are presented. In addition, attendance improved, there was a quicker turnaround for action plans, reviewers saw outcomes in real time, and there was increased multi-disciplinary member input. All of this led to improved efficiency in recredentialing process.

Feedback from physicians was overwhelmingly positive and they could see how peer review was adding value to the organizations. For example, duplicate medication alerts appear in the EHR, primary care providers are alerted about imaging and pathology findings during an ED visit, and wrong-site surgery prevention protocols established by a multi-disciplinary care team.

Today, 100% of the committees are using the digital platform, doctors can use it from any location and identify areas for improvement. Office supply expenses were cut by $5,000 per year and 16.5 hours were saved on average per month.