Automating the Medical Credentialing Process

2 min read
  • Healthcare
  • Legal & Compliance
  • Process Automation

When we meet doctors and other medical personnel in a hospital or emergency room, we assume without thinking that they’re competent and qualified to practice medicine.

But somebody has to make sure — and for obvious reasons. In 2012, 61 cases of fake doctors were reported in California, almost double the amount reported the previous year.

The process of tracking the training and experience of medical professionals is called credentialing, and it’s an arduous one, writes Virginia McCollum, RN, a guest blogger for the Joint Commission’s Ambulatory Health Care Blog.

“One of the most important and difficult responsibilities of an organization is deciding whether licensed independent practitioners are competent to provide quality patient care,” McCollum writes. “It is a process with multiple, time sensitive tasks, which re-cycle every two years. The purpose is to ensure to your organization’s patients that the individuals who are providing care or services are qualified and competent to do so.”

McCollum is quick to note that the rules determining who can practice without supervision vary widely.  ”For example:  Nurse Practitioners are licensed in 14 states as independent practitioners — LIP’s; for the remaining states, they are licensed as practicing ‘under supervision of an LIP.’  Bottom line: check your state for which professions who are licensed to practice independently.” She also notes that while most states require recertification every two years, Illinois requires it every three.

Some organizations do their own credentialing, while others rely upon a Credentialing Verification Organization (CVO).  Either way, it’s a complex multi-stage business process. McCollum’s sample process runs to 14 steps, many of them associated with documents such as letters and certificates, as well as various levels of approvals. It’s a process tailor-made for automation.

Digitizing and streamlining the credentialing process offers a number of obvious benefits for healthcare organizations, including faster turnaround time, decreased costs, and improved security of protected information.  Credentialing often involves the following:

  • Document  capture: Capturing information from a wide variety of media (paper, e-forms, electronic documents, etc.) and data sources
  • Batch processing: Extracting data from a large number of files, eliminating the need for manual indexing, sorting and filing
  • Security: Preventing unauthorized viewing of confidential information (as is possible with paper files), with role-based security features
  • Intelligent routing and notification:  Sending information to credentialing specialists, and alerting them to new tasks with automatic e-mail messages
  • Audit trails: Monitoring and recording the activities that occur during the credentialing process

“It takes a very organized person to keep all information in order and then follow up with re-privileging every two years,” she writes.

McColllum suggests that organizations go back periodically to see how well the process is working, and look for areas of improvement. “Analyze and assess your process — collect data and make improvements based on data,” she writes. “A proactive analysis of the workflow often is very helpful to be sure that the process is working.”

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