Privileges

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Privileges

• Strategies for Deploying and Disseminating

Presented by Andrew M. Allemao
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Keys to Effective and Efficient Privileging

• Move from laundry list to Core Privileges
• Use technology to decrease the manual process for
  disseminating privileges

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Suggestion 1 Migrate to Core Privileges
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Whats Wrong with Laundry Lists?

• Wastes physicians and reviewers 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

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Whats 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

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Whats 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

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Ask Yourself
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?
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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?

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Core Privileging

• The cure for the common privilege process

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Anatomy of Core Privileges

• Predefined criteria for each privilege must
  outline requirements regarding
• Education
• Training
• Experience

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Anatomy of Core Privileges

• Descriptions of privileges and requirements must
  be
• Accurate
• Detailed
• Comprehensive
• Specific

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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

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Which would you rather maintain?
Laundry List
Core
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So Why Dont 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

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Suggestion 2 Use technology to create a less
manual process for disseminating privileges
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Options for Disseminating

• Manual Distribution
• Electronic Distribution
• MSLW installed at all workstations
• MSLW or ECHO with Web Portal

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Manual Dissemination Most Common Least Efficient
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Process for Manual Distribution
Start
Make Copy for Each Nursing Station
Update System and File
Privileges Approved
Collate for Distribution
Nursing Station Updates Book
Deliver
End
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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

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Electronic Dissemination The cornerstone of
electronic distribution of privileges is getting
the privileges tied to providers in MSLW/ECHO
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Options for Getting Privileges into MSLW or Echo

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

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

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Process for Scanning
Attach
Scan
Save
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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

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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

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Options for Getting Privileges into MSLW or Echo

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

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

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Privilege Items in the Software
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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

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MSLW on Every Workstation A good way to spread
the word
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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

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MSLW or ECHO Intranet The best way to spread
the word
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Intranet Solution for Privileges
NU1
NU2
Intranet
NU3
Data Server
IIS Server
NU4
Medical Staff Office
Surgery Scheduling
OR
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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

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Net Solution Pros and Cons

• Pros
• Real time
• Reduced possibility of JCAHO Type I
• No need for photocopies
• Easier for NUs
• Screens designed by the MSO

• Cons
• License required
• IT required for initial set up

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Efficiency Comparison - Ongoing
MSLW/ECHO Net
Manual
MSLW/ECHO
Efficiency
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Hours/Year Ongoing Dissemination
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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.