Is Your Peer Review Process Keeping Up With The Times? Blog Feature

By: symplr on June 21st, 2017

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Is Your Peer Review Process Keeping Up With The Times?

Peer Review Software | Healthcare Provider Credentialing


A key tool for assessment in hospitals and healthcare organizations, peer review is a process that has come a long way and is still evolving. Experts predict that peer review will be increasingly important to improving the quality of patient care. Therefore, it’s imperative to not only understand the history of peer review, but to ensure your organization’s approach is nimble and modern.

The concept of “peer review” has been around since the early 20th century. Then, as now, physicians or medical professionals review colleagues' cases in order to meet various needs for credentialing, re-credentialing, and quality assessment. Plus, hospitals that seek accreditation must participate in peer review. 

One thing changing is the focus of the peer review. Previously, the focus was on a review of cases where there were lapses or oversights in care, often considered as a punitive process by providers. With today’s peer review, the focus is shifting away from an event-driven case review to a proactive, ongoing review of improving quality of care. 

This shift means healthcare organizations are now measuring a physician’s competency and professional performance with the intent to improve patient satisfaction. It means that random cases are reviewed to highlight the things a provider does well and things he or she may not do so well.  Organizations must access the standard clinical policy, the details of a case, evidence from patients and the sensitive assessment of local needs and expectations. A sound peer review program aggregates multiple perspectives so that one individual or one case isn’t the sole determining factor of a review.

Viewed through this new lens, physicians who may fall somewhat outside of established clinical policies or guidelines are not necessarily thought to be breaching good medical practice, but instead may shed light on 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.

The effective peer review of the present 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 to see full details of peer decisions, so they can respond as needed to conclusions. Additionally, it allows providers the opportunity to collaborate with their peers on outcomes that fall outside the norm.  For example, your peer review process identifies a provider that has a higher readmission rate after a surgery than his/her peers.  After working with each of the providers, it is determined that the antibiotic used wasn’t as effective; a simple change in prescribed medicine brings the provider’s readmission rates into alignment and improves patient satisfaction.

If your peer review process is currently conducted on paper, upgrading to an online solution will provide some of the following benefits:

  • Consistent processes
  • Prevent cases from falling through the cracks
  • 24/7 online access to case details by providers and staff
  • Multi-user access to digital documentation
  • Optional anonymous review
  • Increased ability to analyze, track, assess, and share information

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 a review of only ‘negative’ cases. When done correctly, this new approach will reduce costs, lessen risk, and protect against damages, as well as promote the high-quality care which contributes to the health of patients.

Is your peer review process keeping up with the times or is it stuck in the past. This is an update of our previous blog post, "Back to the Future with Peer Review." For more information on how to upgrade your peer reviews to improve patient care, reduce overhead costs, and mitigate risk, contact symplr