Peer Review Battles Go Electronic

(MoneyWatch)  Peer review in hospitals is a very contentious area of medicine. Some critics of the process, which can prevent doctors from having their hospital privileges renewed, say that politically powerful doctors sometimes use peer review to force out competitors. Other critics say that peer review is rarely effective at weeding out incompetent physicians. What's undeniable is that peer review, as it has traditionally been done, is expensive and cumbersome for hospitals.

One hospital that's trying to streamline the process and incorporate it into quality improvement efforts is St. Vincent Indianapolis Hospital. The 500-bed facility, part of a 17-hospital system in Indiana, has begun using peer review software made by Acesis, a Mountain, Calif.-based firm. In a pilot test, the software "trimmed months" off the time needed for peer review, according to Dr. Daniel LeGrand, chief medical officer of St. Vincent Indianapolis.

The conventional way of doing peer review is to have physicians comb through reams of paper charts and then submit their written comments. To simplify this process, St. Vincent has staff members enter key data into the Acesis software and append documents from the hospital's electronic archive of scanned-in reports and lab results. The software allows the reviewers to manipulate records in ways that make it easy to compare data and spot anomalies.

Equally important from St. Vincent's view, LeGrand says, is that computerizing the information helps the hospital share it securely with external reviewers. While St. Vincent is a tertiary care facility, he notes, its doctors include subspecialists who don't have peers on the hospital's staff. There are also turf battles over particular procedures that preclude internal staff review. For example, carotid stenting is done by cardiologists, radiologists, neuroradiologists, surgeons, and neurologists. So if any questions arise about a particular doctor's competence, his work must be reviewed externally. The same is true for rural hospitals that may have only a single surgeon or just one or two doctors in a particular specialty, he says.

St. Vincent is pleased with the results from using the software thus far, and it may expand it to the rest of the hospital and the health system, says LeGrand. As St. Vincent moves forward with other parts of an electronic record, he adds, it should be possible to populate the peer review database automatically. At that point, the program could be configured to allow continuous evaluation of physicians to help the hospital meet the quality requirements of the Joint Commission on the Accreditation of Healthcare Organizations.

LeGrand doesn't deny that some physicians will be fearful of having every nook and cranny of their records examined in this way. Not only could this increase the risk that they might be peer-reviewed, but it could also lead to stiffer requirements for recredentialing. Today, when a doctor's privileges come up for renewal every two years, the hospital looks at rough indicators like mortality and infection rates and length of stay. "But now public and regulatory bodies are saying, 'We want some meaningful evaluation of doctors, and you don't look in the rear-view mirror after two years,'" says LeGrand. ""We're trying to change the culture from reactive to proactive. That way, we'll have a better dialog, and the patients will get better care."

Whether or not peer review software catches on, the larger point is clear: Hospitals are feeling increasing pressure to hold their doctors accountable, and electronic records of some kind will be crucial in achieving that goal.