QualOptima Professional Practice Application Version 1.5
Proctoring is the objective process used by healthcare organizations to evaluate the current clinical competence of physicians and other clinical “practitioners” to perform clinical diagnostic, treatment and assessment procedures. The proctoring process is required by Joint Commission Standards for practitioners to be granted defined clinical privileges to perform such procedures by healthcare entities. Proctoring is required to evaluate the clinical competency of new medical staff members and existing medical staff members who request new privileges.
QualOptima v1.5 is the proctoring application of Q’s technology with embedded clinical content and metrics for analytics designed with precise performance and outcomes measures, related to individual patient risk and fitness factors, to evaluate clinical competence. Rather than the traditional but weak methods that have been used without QualOptima technology, where proctors are usually not compensated and may not even be available within the organization, QualOptima provides the complete technology solution for proctoring. The technology is also available to medical device manufacturers for education, mentoring and measuring clinical performance and outcomes for their products.
Proctoring Definition and Requirements
The American Medical Association (AMA) defines “proctoring” in a Report by its Board of Trustees as follows:
“Proctoring is an objective evaluation of a physician’s actual clinical competence by a
monitor or proctor, who represents the medical staff and is responsible to the medical
staff. When an initial applicant seeks privileges or an existing medical staff member
requests new privileges, they are proctored or observed while providing the services
for which privileges are requested. Monitoring or preceptorship are other terms for
this method of assessing current competence.”
Proctoring is required by Joint Commission Standards in the process of Focused Professional Practice Evaluation (FPPE) in the following three (3) types of circumstances:
- New applicants for medical staff membership
- Existing practitioners requesting new privileges for which the hospital has no documented evidence of their competence
- Practitioners whose current abilities are questioned because:
- There are negative performance issues, or
- An adequate volume of cases are not available to assess current competence
Proctoring Clinical Performance in the FPPE-OPPE Framework
Medical Staff Standards require that clinical performance evaluation decisions occur both at initial appointment and consistently throughout membership, including again at reappointment at least every two (2) years. Proctoring is required for new practitioners and practitioners requesting new privileges. The third instance for proctoring occurs if current privileges come into question during ongoing evaluation processes, for example if there are patterns and concerns identified by triggers and measurement of performance criteria.
QualOptima is in initial release versions and fully developed to implement performance measurement and triggers; the Proctoring Application QualOptima v1.5 is scheduled for licensing to reference sites in Fall 2014.
Ongoing Performance Measurement with Standardized Proctoring Metrics
Once a healthcare organization implements performance and outcomes measurement using the Proctoring Application of QualOptima v1.5, as electronic machine reading, learning and with Q’s analytics, there is no logic in not continuing electronic monitoring during the periods of OPPE.
The sources of information regarding practitioners can be the same sources for both FPPE and OPPE as required by the Joint Commission, including:
- Chart review
- Direct observation techniques
- Monitoring clinical practice patterns
- External peer review
- Discussion with other individuals involved in the care of each patient,
including consulting physicians, assistants at surgery, nursing, and
Electronic clinical performance measurement technology with QualOptima is ideal for use with each of these sources.
Remote Proctoring/Mentoring with QualOptima v1.5
Proctoring is a form of focused evaluation involving one-on-one evaluation of a practitioner’s performance by another peer practitioner (a “proctor”). Direct observation is sometimes used to gauge the ability of the proctoree to perform a procedure or to use a new technology. However, the impediments to direct observation often make it difficult to use in the treatment of patients for many reasons. Q intends to continue design of additional technology to empower remote proctoring, and the medical literature demonstrates success in limited use of similar technology.
Focused proctoree evaluation may occur retrospectively through peer review if on-site, real-time evaluations are not feasible. In the case where same-specialty reviewers are not available internally, external peer review can be used as a viable substitute for on-site proctoring. These circumstances make QualOptima the clear choice for remote proctoring technology.
Converging Forces for Evaluations from Clinical Performance Proctoring
Simultaneous with the FPPE-OPPE Standards requiring performance measurement, proctoring and triggers, other forces from both the public and private sectors are converging:
- Organized medicine is publishing precise clinical performance measures as metrics
- States are imposing upper limits (“caps”) on medical malpractice liability claims resulting in multiple plaintiffs litigation focused on negligent credentialing claims
- Medical malpractice insurance carriers and hospital self-insured trusts are instituting underwriting and establishing premiums and giving incentives in consideration of healthcare organizations with aggressive performance & outcomes measurement
- Medicare & Medicaid are rapidly moving to more intense pay-for-performance and value-based purchasing
- Payers (health insurance companies) are more rigorously scrutinizing preferred providers and “in-network” providers
- Patients and their employers are more actively engaged in provider selection and personalized care information based on their conditions (risk and fitness factors)
- Wellness, preventative, patient population and engaged patient strategies are becoming more dependent on performance & outcomes
The reality for healthcare organization is that the burden of FPPE-OPPE is far more demanding than the usual and customary methods of manually abstracting data from medical records using full-time employees in the Quality, Risk and Medical Staff offices is able to process. However, the organized medical community of professional organizations, recognizing that payers and the government are moving rapidly to value-based purchasing of services – no longer “fee-for-service” but “fee-for-value” – are at the same time generating extensive clinical metrics, precise clinical performance measures. Healthcare organizations not relying upon such measures are at extraordinary professional liability risk.