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Human Resources: Ferreting Out the Unfit

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A national database is a tool, not a panacea, for healthcare worker background checks.

After some 13 years of bureaucratic delay, the federal government is now providing hospitals with access to a national database that records disciplinary actions taken in the 50 states against all licensed medical professionals.

The Healthcare Integrity and Protection Data Bank, created in 1997 under Section 1921 of the Social Security Act, already has data compiled from state medical professional licensing boards across the nation, but hospitals haven't been able to access it, until now.

The Office of Management and Budget gave its final approval in late January, so the data will be dropped into the already accessible National Practitioner Data Bank, which monitors physicians and dentists.

"It will give the entities that have the ability to inquire into information in NPDB far more information than they had in the past," says David Bowman, a spokesman for the Health Resources and Services Administration. "The major consequence will be that private-sector hospitals will have access to adverse licensure actions taken against all licensed healthcare professionals, nurses, podiatrists, chiropractors, and not just physicians and dentists, as was the case before."

While the databank will facilitate background checks, it is not a one-stop shop for healthcare professional vetting. In fact, it's already created a new set of issues.

First, there is the question of who can—and who cannot—access the data. Mostly, the data will be limited to hospitals and medical and professional associations that conduct formal peer review. That leaves out temporary nurse staffing agencies, which would greatly benefit from the access, says Marcia Faller, executive vice president and chief clinical officer of San Diego-based staffing provider AMN Healthcare.

"We are trying to do the right thing. We don't always have access to the information we need," Faller says. "Instead, we rely on the state boards of nursing to give us the information we need to know about whether or not a nurse's license has been suspended or revoked."

Faller says staffing agencies can access the data directly if they are designated an agent of a provider "but that is not something that is rampant out in the industry."

Bernard H. Becker, vice president and chief human resources officer at Topeka, KS-based Stormont-Vail HealthCare and member of the Kansas State Board of Nursing, says he's not sure if a national data base will be all that helpful.

"My perspective on the exchange of information between states is that it's very inefficient and haphazard and hit-or-miss," he says. "Merely for the federal government to legislate an obligation to share information doesn't mean that is going to happen. You've got 50 different state regulatory agencies in nursing that by statute and regulation in each state says, 'Here is what you can share and here is what you cannot share.'"

There are also technological hurdles that have to be cleared. "Even if we want to share that information and we are given free rein and safe harbor from future claims by licensees that we are sharing information inappropriately, making that happen is still going to be difficult because you don't have a common database that all 50 states are part of, at least in the nursing world," Becker says.

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