It's not revolutionary for states to roll out a universal credentialing application—they exist in a number of states from Georgia to Iowa. But the statewide credentialing (and some suggest privileging) database that Washington state is working on is new territory. And at some hospitals, the effects are already being felt.
"We're all very anxious to make it move forward, especially the [credentialing] database—the privileging part we have a lot of reservations about," says Rita Rakestraw, CPCS, educational committee chair of the Washington Association of Medical Staff Services and one of the MSPs who helped develop the state's universal credentialing application in 1999.
The project began when the state legislature passed Senate Bill 5346 (SB 5346) in April 2009. Its overarching goal is to simplify healthcare delivery and lower costs. As part of that goal, the state is aiming to establish a statewide credentialing database and streamline some privileging practices—both of which will have a significant impact on the medical staffs at hospitals.
However, implementation of the bill is slow, and the involved parties are still working through the details. Those parties include Washington Health Forum, OneHealthPort, and Medversant.
Like the universal application, the online database is designed to be a time-saver for practitioners. "They wrote this bill to create a uniform database that a practitioner could go in and fill in his information once, and every entity that needed to get the information from a practitioner could link to that," says Rakestraw. However, there are some usability issues that still need to be addressed—e.g., how practitioners will scan nonelectronic documents, such as DEA registrations, to enter them into the system.
"They're assuming, number one, that all practitioners have scanners and they're going to be able to do this smoothly—and are going to want to do this," she says.
Other pending usability questions include:
Most of the uncertainty surrounding SB 5346 stems from the privileging aspect of the bill. The final version of the bill states that by December 31, 2010, the lead organization shall "Develop a uniform electronic process for collecting and transmitting the necessary provider-supplied data to support credentialing, admitting privileges, and other related processes" (p. 5, Second Substitute Senate Bill 5346, effective July 26, 2009).
In the bill, privileges are only mentioned within the context of admitting privileges. However, MSPs involved in the implementation of the bill say that OneHealthPort has interpreted the bill to mean that all clinical privileges should be similar from one hospital to another.
"Most of my peers who work in this field tried to say that you really can't add privileges to this [SB 5346 implementation] because privileges are site-specific according to Joint Commission standards," says Rakestraw.
However, OneHealthPort and Medversant have set the bar high. "They're just determined to try to simplify this," she says.
Even non–Joint Commission–accredited facilities typically adhere to the best practice of establishing privileges that are site- and resource-specific. Therefore, this proposal raises questions for them too.
There is no final decision at this point, and all involved parties are having ongoing conversations about how best to manage the privileging aspect.