Privileges
Strategies for Deploying and
Disseminating
Presented by
Andrew M. Allemao
Keys to Effective and Efficient Privileging
Move from laundry list to Core Privileges
Use technology to decrease the manual
process for disseminating privileges
Suggestion 1:
Migrate to Core Privileges
What’s Wrong with Laundry Lists?
Wastes physician’s and reviewer’s 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
What’s 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
What’s 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
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?”
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?”
Core Privileging
The cure for the common
privilege process
Anatomy of Core Privileges
Predefined criteria for each privilege must
outline requirements regarding:
Education
Training
Experience
Anatomy of Core Privileges
Descriptions of privileges and requirements
must be:
Accurate
Detailed
Comprehensive
Specific
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
Which would you rather maintain?
Laundry List
Core
So Why Don’t 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
Suggestion 2:
Use technology to create a
less manual process for
disseminating privileges
Options for Disseminating
Manual Distribution
Electronic Distribution
MSLW installed at all workstations
MSLW or ECHO with Web Portal
Manual Dissemination
Most Common – Least Efficient
Process for Manual Distribution
Start
Privileges
Approved
Nursing Station
Updates Book
End
Make Copy for
Each Nursing
Station
Deliver
Update
System and
File
Collate for
Distribution
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
Electronic Dissemination
The cornerstone of electronic
distribution of privileges is getting
the privileges tied to providers in
MSLW/ECHO
Options for Getting Privileges into
MSLW or Echo
1. Attach scanned image of the approved
privilege form to each provider record
2. Have privilege templates in MSLW
or ECHO and enter the approved
responses
Process for Scanning
Attach
Scan
Save
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
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
Options for Getting Privileges into
MSLW or Echo
1. Attach scanned image of the approved
privilege form to each provider record
2. Have privilege templates in MSLW
or ECHO and enter the approved
responses
Privilege Items in the Software
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
MSLW on Every Workstation
A good way to spread the word
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
MSLW or ECHO + Intranet
The best way to spread the word
Intranet Solution for Privileges
NU1
NU2
NU3
Intranet
Data Server
IIS Server
NU4
Medical Staff
Office
Surgery
Scheduling
OR
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
Net Solution: Pros and Cons
Pros
Real time
Reduced possibility
of JCAHO Type I
No need for
photocopies
Easier for NU’s
Screens designed by
the MSO
Cons
• License required
• IT required for initial
set up
Efficiency Comparison - Ongoing
Manual
MSLW/ECHO
Efficiency
MSLW/ECHO
+ Net
Hours/Year – Ongoing Dissemination
80
70
60
50
IT Support
Training
Copy/Distribute
40
30
20
10
0
Manual MSLW / Prod +
ECHO
Net
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.