Healthcare Credentialing | symplr Blog

Back to the Future with Peer Review

Written by Melissa Outlaw | Sep 29, 2015 12:56:32 PM

Thirty years ago, Doc made fictional history with a flux capacitor, some lighting, and a DeLorean traveling at 88 mph. While we haven’t been able to go to the future (much less back to the future) yet, I’d like to bet that in the real-life 2015, Doc would receive a stellar peer review. Grab a seat and let’s take a journey back to the future with peer review…

While it may have been seen as punitive in the past, peer review is definitely not a practice that is going to fading away. In fact, experts are predicting that peer review will be increasingly important for practices focused on improving the quality of patient care. To understand where peer review is going, let’s first take a trip to understand its history... 

Until recently, “peer review” has been a sort of catch-all phrase. Physicians or medical professionals review their colleagues' cases in order to meet various needs for credentialing, re-credentialing, and quality assessment. Plus, hospitals that are seeking accreditation must participate in peer review.

Previously, individual or department goals were often focused on making sure basic standards for quality of care had been met. So it’s sort of like riding a skateboard vs. a hover board. Sure, a skateboard gets you moving but it is basic compared to a levitating hover board. Generally the focus was on a review of cases where there were lapses or oversights in care, which could potentially lead to claims of malpractice. With today’s hover board peer review, the focus is shifting away from the case to a focus on the care provided – and how the overall quality of care can be improved.

Case review is now just one portion of the peer review process. A physician’s competency and professional performance should be based on multiple sources. It must take into account the standard clinical policy, the details of a case, as well as evidence from patients and the sensitive assessment of local needs and expectations. So what’s the “Great Scott!” takeaway here? Multiple sources means a peer review aggregates multiple perspectives so that one person isn’t able to dictate your whole review or throw anything off.

Under this new approach, physicians who may hover outside previously rigid clinical policies or guidelines are not necessarily thought to be breaching good medical practice. It recognizes that there might be other factors that influence patient care. For example, patient preference, availability of services, and consideration of the individual risks and benefits to that patient are incorporated into the review process, and then reviewed by a colleague with a similar background or credentials.

In the past, peer review was often viewed as a form of discipline or damage control (like a skateboard with broken wheels). The hover boarding peer review of the future is proactive, focused on prevention, and transparent – which gives everyone the information they need as it makes sense for their role in the process. In the case of a negative review, the new approach allows physicians too see full details of peer decisions, so they can respond as needed to conclusions, which may have a negative impact.

The results are seen in numerous areas:

  • Helpful for in-house needs
  • Useful for accountable care organizations (ACOs) and insurance companies
  • Provides data to find trends, learn how the organization is doing, and identify opportunities for improvement

As one might expect, upgrading to a hover board comes with some technological advances. The use of technology plays a significant role in the future of peer review. New software and digital solutions are designed to streamline the paperwork-heavy process.

Some of the benefits of the new peer review:

  • Organization and formalization of the process itself
  • Multi-user access to digital documentation
  • Optional anonymous review
  • Improved tracking and sharing of data
  • Increased ability to analyze, track, assess, and share information

This improved data-driven analyses means there are improved statistics, as well as the ability to provide accurate and measurable results. And this streamlined process with the use of new technology also means hospitals and medical organizations can increase physician participation in the peer review process. Not only does a digital peer review make it easy for physicians to jump on board, but does so without disrupting their current workflow. And it can also track who is doing their part to contribute. And for those who help out, there might even be special incentives, bonuses, or recognition (depends on the preferences of their facility).

Ultimately, the goal of peer review is to continue to add value to the patient experience, and raise the standard of patient care over time. This happens through a focus on quality of care, as opposed to case guidelines. And when done correctly, this new approach will reduce costs, lessen risk, and protect against damages, as well as promote the quality care which makes patients happy and healthy!

Don’t get stuck rolling down the roads of yesterday, the future for peer review is happening now! For more information on how to upgrade your peer reviews to improve patient care, reduce overhead costs, and mitigate risks, contact the experts at symplr, today!