The way some physician performance is being reviewed – from those who are working on the battlefield to those serving in rural areas and teaching hospitals – is changing and for the better, thanks to technology.
For more than 10 years the Army has been using a battlefield medical record system called Medical Communications for Combat Casualty Care (MC4). Lieutenant Colonel William E. Geesey, the product manager for MC4 Product Management Office, says it is a “system of systems.” He says it not only provides continuity of care but also allows commanders to collect near real-time data to identify trends and outbreaks.
The system also allows practitioners to conduct remote peer review of medical documentation wherever active military operations are in progress.
Col. Roman Bilynsky, who served as the deputy commander for clinical services, for Task Force 115 Medical at Camp Bucca, Iraq, from 2008 to 2009, wrote about his support for the technology in a December 2009 article published in MC4’s online newsletter.
“The ability to sort patients by provider and immediately view notes was superb,” he wrote. “It would be extremely labor and time intensive for treatment facilities to locate paper medical records for review. Instead, a reviewer can sit at an MC4 laptop and pull up notes from current or past providers for a quality assurance assessment.”
Bilynsky believes technology is changing the way providers train and administer healthcare.
“It is possible that providers may participate in some form of virtual reality training in the deployed environment in the near future,” he said. “The proliferation of Webcams and Voice over Internet Protocol (VoIP) communications, in conjunction with MC4 systems, may provide the ability to see and hear remote patient evaluations and observe a provider's interpersonal skills via the Internet or satellite uplink,” he said.
The Texas A&M Health Science Center Rural and Community Health Institute (RCHI), a resource for physicians and healthcare facilities operating in rural areas, is already doing just that.
In 2003 it developed the Rural Physician Peer Review Program (RPPR) to address a special need of rural hospitals-physician peer review. The program uses e-technology and teleconferencing to bring physicians of like specialties together across the state to discuss patient care.
Currently, fifty-three hospitals are participating, said Kathy Mechler,
COO, and do-director of the institute.
“The feedback that we have received from the rural hospitals include a wide span of continuous improvement projects focusing on projects such as forms revision for medication reconciliation to improving outcomes based on CMS/TJC [Joint Commission] core measures,” she said.
Mechler says the physician peer review model has been adapted to include nursing peer review.
University of California, San Francisco (UCSF) Division of Hospital
Medicine is not only using technology to assess its physicians and cases, but also to make improvements, said Arpana Vidyarthi, MD, its director of quality and assistant professor.
Using a software-as-a-service solution from Silicon Valley based Acesis, UCSF automated its I-Care (Inpatient Case Review) for assessing physician and system performance.
“The software allows us to look at our own local data in any shape, way or form. We can look at any element of the review form to see trends that we may not have otherwise seen,” said Vidyarthi.
This real-time analysis, she says, enables them to make culturally appropriate improvements. But she says UCSF is not alone in taking this approach.
“There has been a change in the environment of quality and safety,” Vidyarthi says. “That environment is driving a closer look at how we take care of business and take care of patients.” And it is growing, she adds.
However, she points out that it is “incredibly difficult” to keep up with the growth without a technology platform.
