It's time consuming, tedious, and often just plain uncomfortable for everyone involved. But, like most things in life that are unpleasant, peer review is necessary and unavoidable. So necessary that the Joint Commission has made Ongoing Professional Practice Evaluation (OPPE) part of its 2009 Standards Update. The Commission is urging hospital leaders to gather and analyze data on performance for all physicians with privileges on an ongoing basis rather than at the two year reappointment process.
The idea, of course, is that compiling data on a regular basis will allow the physician to improve performance before something dire occurs. Unfortunately, the administrative burden of conducting ongoing peer reviews has kept the majority of hospitals from increasing the frequency of their evaluations. Which is completely understandable—a doctor's time is stretched thin as it is, and each physician review requires the reviewer to spend precious hours poring over boxes of medical records, which often have to be shipped at great cost to the hospital to far flung locations throughout the country.
It was that burden, combined with a desire to streamline the peer review process that led Daniel LeGrand, MD, chief medical officer at St. Vincent Hospital in Indianapolis to try out a new Web-based software system that he'd been told would simplify and modernize the procedure. Now several months later, St. Vincent is wrapping up a pilot project to review several doctors in complex sub-specialties using a software system from Silicon Valley start-up Acesis. LeGrand says the pilot was so successful at simplifying the peer review process that the hospital will begin performing peer reviews throughout each department on an ongoing basis, as recommended by the Joint Commission.
"We were in need of doing an external peer review on a group of sub-specialists. And the reason we got to that point was because these doctors were competitors and their specialty crossed over into other specialty areas. We didn't have the expertise locally to do a thorough and meaningful peer review," says LeGrand. "The traditional way to do this was to pack up a few charts and send along to a reviewer. We happen to have three in different parts of the country, which means expensive shipping and the risk of security issues."
Enter Acesis—currently the only company offering an online physician peer review product of its kind, according to company CEO Kevin Chesney. The program is an on-demand subscription service that allows hospitals to customize the review process for each medical specialty. Hospital administrators define templates using their own "triggers," such as infections, return to operating room for bleeding, mortalities, and other associated injuries. Online delivery lets physicians and peer reviewers participate anytime from anywhere, which was an especially important feature for LeGrand.