Background Check: Automating Medical Credentialing at a Major Medical Center

The Hospital

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The university medical center is made up of five hospitals, a college of medicine and public health, two research institutes, and a network of more than 30 medical facilities throughout its home state. Its largest hospital contains approximately 1,000 beds. The medical center’s three main hospitals alone total more than 2,000 doctors and residents. The medical credentialing department at the medical center is responsible for verifying the records and checking the backgrounds of every one of those doctors. That department is also charged with maintaining medical school alumni records and the credentialing documents and official files of all the doctors previously employed at one of the three hospitals. Considering that public health is one of the most important concerns in our society, these records are very extensive and can be quite a lot to manage properly.

The Need

The systems administrator for corporate credentialing at the medical center is part of the team accountable for the proper maintenance of doctors’ records and the credentialing process. In the summer of 2004, she began looking for an imaging system that would enable her department to manage their multitude of doctors’ records electronically. Her initial search was for an electronic document management system (EDMS) that could integrate with their existing software applications and eliminate a lot of their hard-copy files. After preliminary discussions with a locally based EDMS provider, she began working with another department within the university that had experience with EDMS and Optical Image Technology’s DocFinity software suite. Together, they discovered that DocFinity could assist the medical center’s credentialing department in ways far beyond imaging.

The Solution: BPM/Workflow, electronic forms, and electronic signatures

The medical center settled on a DocFinity EDMS package that included the DocFinity Core, which is the heart of the DocFinity suite. The Core contains—among other functionality—imaging and an API which allows them to integrate easily with their existing software products. They also purchased DocFinity add-on components for electronic forms management, electronic signatures, and workflow to automate the credentialing process. With the installation of these add-on modules, the credentialing department is able to scan and electronically manage the hundreds of thousands of doctors’ files. They can also automate the credentialing process, streamlining necessary procedures and making the entire ordeal easier for doctors, staff, and the approval board.

Under the direction of the credentialing department, the IT manager was able to take the paper-based application forms and turn them in to electronic, Web-based forms that applicants filled out on the medical center’s Web site. Using DocFinity’s electronic forms management capabilities, he reproduced the 15-page document, as well as more than 40 different privilege applications. “I’ve really enjoyed working with the DocFinity e-forms module,” he says. “It’s one heck of a product.”

After a doctor completes the online form, it’s automatically passed to DocFinity BPM/Workflow to be electronically routed through the credentialing process. The workflow design, also devised by the IT staff under the direction of the credentialing department, moves the application from person to person as each completes their necessary tasks before the software moves the application to the next step in the process. All 17 departments within the hospital play a role in the workflow process because, depending on the specialty of the doctor, different departments will need to be involved in the verification and approval process. DocFinity will automatically route the form to the proper department on the correct track depending on the information included in the online form. There are about 75 people involved in the process for each application, plus approximately 100 additional doctors that securely store electronic signatures within DocFinity.

“The simple workflow designer allowed us to implement all of the tasks and checks that we wanted with room to spare,” the IT manager notes. “We were able to produce this procedure with relative ease and are looking forward to the reporting and measurement capabilities that the auditing of the process will provide.”

The Credentialing Process - Workflow

The credentialing workflow for a new doctor begins with the doctor filling out a pre-application form that will create an online account and assign an applicant number. That number is emailed to the doctor, at which time he is instructed to fill out the entire 15-page application on the Web. After the application is filled out, the completed form is sent to the hiring agent for the applicant. The hiring agent completes various tasks—supplying the document to managed care groups who add more documents to the file. When those functions are complete, the entire file enters the actual credentialing process.

The agent in the credentialing office who receives the document is responsible for ensuring that the document meets the processing standards of the medical center. If the file passes muster, it’s forwarded to the corporate credentialing group, which prepares the file to meet even more standards. More documents are added to the file, and when it passes that step, it is sent on to the corporate manager for a final review.

After an initial “OK” from the corporate manager, the file goes to a department chair for review. Using DocFinity’s electronic signature capabilities, the department chair will electronically “sign” the document if it is approved. Security throughout the process is a top concern and DocFinity ensures the integrity of the credentialing procedure. The electronic signatures are encrypted and hashed in such a way that they can only be altered by those who are assigned rights to do so.

Once approved by the department chair, the file goes back to the corporate manager who compiles more information to be presented to the credentialing committee for authorization. By law, the application package must be in front of the committee by 30 days after its completion. DocFinity ensures that that happens.

Assuming the committee approves it, the data reports from the file are automatically sent to the Medical Staff Administrative Committee and then on to the hospital board for its final approval and activation in the corporate system. After this intensive procedure is completed, the doctor may finally practice at the hospital. Of course, the process is repeated every two years for each doctor and every time they request new privileges, such as specialized surgical procedures and treatments. By leveraging the powerful capabilities of electronic forms, workflow, and electronic signatures, the credentialing staff was able to significantly increase the efficiency of the process, not to mention avoid a lot of headaches for itself, doctors, and board members.

Results

In the end, the electronic routing of the application has drastically improved the credentialing process—no more misplaced applications or files, and the documents aren’t just piled on the desks of those involved in the process. With 2,000 doctors working in the medical center at any given moment, and hundreds of thousands of former-employee and alumni records, the electronic storing and automation will improve their operations and save the medical center time and money. Plus, the full, table-based and administrator-controlled security of the entire DocFinity suite keeps the documents and their progression through credentialing more secure than a traditional, paper-based system.

The systems administrator for corporate credentialing says that the electronic forms “will have a major impact on the credentialing process by moving our operations and processes to total electronic storage and enabling the passing of electronic files to so many individuals for tracking and approval.”