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In today's consumer-driven world, isn't it frightening that most patients know little more about their doctor's qualifications than what they see hanging from an office wall? While they can access detailed qualification information about their mechanic, it is in that most vulnerable of situations -- putting their family's health in another's hands -- that they must rely on sheer hope of professional qualification and expertise.
Medical credentialing is increasingly important because it is the one procedure that allows patients to confidently place their trust in their healthcare providers. Through a standardized process involving data collection, primary source verification and committee review, patients are assured of their healthcare professional's merit and experience. With the advent of Web services and other technology innovations, electronic credentialing processes offer further assurances by making real-time qualification monitoring and proactive protection against medical errors possible for the first time.
 What is Electronic Credentialing?
So what is electronic credentialing? Electronic credentialing generally involves one or more of the following attributes: 1) a provider portal allowing electronic submission of provider information, 2) a centralized provider data repository, 3) automated electronic verification of provider information, 4) virtual committee functionality and 5) integration of provider information to upstream and downstream systems. Through these tools and improved processes, efficiency and patient safety are simultaneously improved.
Electronic Credentialing and Reduction of Medical Errors
As healthcare reform legislation expands coverage to millions of new patients and increases demand for healthcare services, it is expected that the risk of medical errors will grow exponentially as well. Medical errors are already responsible for the deaths of 98,000 Americans each year, a statistic that has impelled industry leaders to fight for enhanced standards of competency and greater disclosure of recorded disciplinary actions against healthcare workers.1 Yet organizations continue to use slow, paper-based credentialing processes that never truly guarantee transparency of providers' credentials. Instead, with one simple human error in the current paper-based credentialing process, a nurse can be authorized to perform services beyond his experience, or a physician with an expired license can be allowed to continue to practice. In these cases, infrequent and indifferent credentialing lays the perfect foundation for increased medical errors, claims fraud, and liability for affiliated healthcare organizations. This can also have serious negative ramifications to patient safety, a physician's professional survival and an affiliated institution's reputation.
Legal Consequences
Prior to 1965, hospitals were considered charitable organizations and immune from being sued for negligence. Much has changed, and plaintiffs' attorneys are now drawing a causal link between medical errors occurring in as many as one-third of hospital admissions, as reported in the journal Health Affairs, and negligent credentialing, thereby laying the legal responsibility at the feet of the organization.
Today, in most states, if a clinician has behavioral issues or other problems with their qualifications that should have been revealed by effective credentialing, the facility can be held responsible for any harm caused to patients by that provider. As an example, consider the Utah Supreme Court, which recently reversed an earlier decision against a woman who had brought claims of malpractice against the physician who mishandled her abdominal surgery at St. Mark's Hospital in Salt Lake City. The plaintiff, whose subsequent treatment included six corrective surgeries, claimed that St. Mark's was negligent in credentialing the surgeon. The court ruled that St. Mark's held the ultimate responsibility for medical staff decisions and recognized negligent credentialing as a viable common law claim.
State courts across the country have concluded that healthcare organizations are legally bound to increase patient safety and reduce malpractice cases. To accomplish these goals, healthcare organizations must focus efforts on the primary line of defense against medical errors and resulting liability: electronic credentialing.
Outsourcing as an Option
As organizations focus further energies on preventing medical errors, electronic credentialing will become the dominant process within the healthcare industry. Unfortunately, the vast majority of healthcare organizations today perform the only type of credentialing they have capabilities for on their own: manual credentialing. Credentials Verification Organizations (CVOs) provide an outsourced alternative for struggling organizations. To see drastic improvement, healthcare organizations must find a CVO utilizing a shared Web-based platform with real-time credentialing functionality. This type of partner will provide an effective turnkey approach for achieving continuous, electronic credentialing.
Now, more than ever, healthcare organization leadership is expected to ensure greater patient safety, reduce medical errors and lower costs. Real-time electronic credentialing can be a significant factor in achieving these goals.
Matthew Haddad is president and CEO of Medversant Technologies, LLC. As a health care industry consultant, Mr. Haddad has arranged financing and provided interim management to acute care facilities, skilled nursing facilities, psychiatric care facilities and assisted living centers.
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