Daren Smith, RN, BSN, is a clinical solution specialist for AmkaiSolutions and Surgical Information Systems.
Q: To maintain compliance with Medicare and accreditation standards, ASC physicians are required to undergo peer review. Why is this difficult to accomplish?
Daren Smith: First, physicians are ultimately responsible for conducting peer review. Physicians are very busy, and motivating them to complete peer review can prove challenging. This is especially true when you put paper charts and paper forms in front of them.
Second, getting physicians to complete peer review correctly can be just as challenging. It is not unusual to see physicians simply give their approval — write "yes" — in response to every question concerning whether a chart is complete, even if this is not necessarily true, and then sign off on the chart.
This allows the physician to complete the peer review process quickly, but leaves the ASC vulnerable. If a surveyor comes in, compares a peer review form to a patient chart and finds a discrepancy, it will completely negate all of the peer review credibility and put an ASC's accreditation status in jeopardy.
Q: How does Amkai help clients overcome these obstacles to meeting peer review requirements?
DS: We understand the challenges our clients face, and built functionality into AmkaiCharts EMR to make the process simple. Since our clients desire flexibility, AmkaiCharts gives them multiple options for completing peer review.
First is with the use of an internal email system, which allows the ASC and the physician to send and receive peer review forms and charts for review electronically. This makes it easier for the physician to review the chart, fill out the form and return it back to the administrator or other member of the ASC staff tasked with overseeing the peer review process.
The other — and I would say more innovative option for completing peer review — is through chart audit functionality Amkai recently added. This functionality allows an ASC to identify the chart criteria it wants physicians to review and produce a report that determines whether or not that criteria has been met.
Examples of such criteria include the following:
- Was the history and physical (H&P) present?
- Was anesthesia assessment completed?
- Did the physician sign off on the H&P?
- Was the American Society of Anesthesiologists (ASA) Score identified?
Within AmkaiCharts, an ASC can put any desired criteria in the chart audit and print out a report stating whether that information is present in the chart or not.
With that report, physicians can confirm whether such information is included in the chart without clicking through each portion of the chart. The report would identify missing information, and physicians would just need to make the appropriate indication on the review form where information is missing, incomplete or incorrect.
This should allow physicians to complete the review process quicker because they do not need to search through every section of a chart.
Q: Can ASC administrators review their physicians' peer review work in AmkaiCharts to ensure compliance?
DS: Yes, they can; verification is also completed electronically. This makes the process faster on their end as well. By using either of the two options in AmkaiCharts, physicians and administrators spend less time on peer review and complete the process with greater accuracy than they would using a paper-based system.