Kathy Mechler, COO and co-director of the Texas A&M Health Science Center (HSC) Rural and Community Health Institute (RCHI), a resource for physicians and healthcare facilities operating in rural areas, shares how the institute is using technology to improve the peer review process, in a Q&A with Healthcare IT News.
Can you provide background about the RPPR program at RCHI?
The Rural Physician Peer Review (RPPR) program administered by the Texas A&M Health Science Center Rural and Community Health Institute (RCHI) is internal in nature since the peer review committees are comprised of the staff of participating peer review organizations. The program provides physicians with an option to keep current with best practices in an environment that promotes case-based learning and continuing medical education. The program originated in 2003 with two facilities and has grown to 53 as of March 1, 2010. HSC-RCHI coordinates peer review activities for specialties including family medicine, family medicine-obstetrics and gynecology, obstetrics and gynecology, general surgery, internal medicine, pediatrics, emergency medicine, and orthopedics. Arrangements can be made for other specialty reviews.
Why was this program created?
The program has been developed to address the needs of health care organizations, primarily hospitals and ambulatory settings, to meet the challenges and complications of peer review for small medical staff. Furthermore, the program helps reduce or eliminate potential conflict of interest and restraint of trade concerns. The program offers medical staff the opportunity to objectively evaluate the quality and appropriateness of care they deliver in a manner that is fair and unbiased. Objective, impartial reviews are made by a peer review committee consisting of members with the same specialty, which are not in economic competition or partnership with the professional under review.
Are these individual physician reviews or case reviews – or both?
Cases for reviews are submitted by the individual hospitals for physicians on a case-by-case basis. Participating facilities have criteria from which they select the medical record(s) to be reviewed. The peer review program reviews one physician per medical record that is identified by the facility. Physicians participate in reviews based on the specialty that the physician is credentialed for, e.g., an internal medicine physician will go into an internal medicine peer review meeting [conducted via a secure conference call].
How many peer reviews are conducted each year? How many physicians participate in the program?
We currently have 53 rural hospitals enrolled in the program, with 582 physicians having been listed by the hospitals as having privileges. For the year 2009, the HSC-Rural and Community Health Institute conducted 230 meetings involving 1,326 records and awarding 2,226 CMEs.
How are EMRs used in conducting the peer reviews?
Each medical record is completely de-identified. The blinded medical record is placed into an encrypted and password-protected location. Physicians have the ability to review the records online [through a HIPAA compliant, secure Web portal] from their home, clinic, hospital, etc. A few of our peer review hospitals have the ability to electronically send us their records.
How are physicians responding to the program?
Some comments physicians have made about the Rural Physician Peer Review program:
1. "I enjoy the reviews. They help me do a better job on my own records!"
2. "Thank you for this opportunity to serve in this peer review capacity. It has
been enlightening and educational for me. It is helpful to know that we all
struggle with the same issues as we try to provide excellent health care for our
patients in many different settings. I thank you, the other RCHI staff, and the
physician moderators, as well as other physician participants for making this an
enriching experience for me."
What types of quality improvements are hospitals making by participating in this
process? Are they noticing any trends?
The feedback that we have received from the rural hospitals include a wide span of continuous improvement projects focusing on projects such as forms revision for medication reconciliation to improving outcomes based on CMS/TJC core measures. Hospitals are provided with reports showing improvement in quality and safety issues such as, "The Joint Commission does not use abbreviations," physician and clinical legibility, telephone/verbal orders and read backs, and reduction in communication barriers such as premature closure, authority gradient and handoffs to name a few.
Are any new developments planned for this program in the future?
Future development of the program includes expanding participation to additional hospitals and clinics. The HSC-Rural and Community Health Institute has adapted the physician peer review model to now include nursing peer review.
Find out more about the program here.
