Although public manifestations of IT tend to get most of the attention in health care -- electronic health records, personal health records, security breaches and the like -- other, more internal IT evolutions are also changing the industry from within. Some of them, especially those that save money, improve the quality of care and make life easier for physicians, may serve to speed up the adoption of the more public forms of IT.
Physician peer review -- a tedious, time-consuming, paper-based process -- is moving into the digital age. The review of one physician by others of similar experience and training is a standard, mandated form of quality control and one of the primary methods of monitoring and improving patient care.
A new, online peer review process in the testing stages at several hospitals for much of this year is going public next week. If it becomes a widely embraced alternative to doing it "the old way," as some physicians predict it will, it could hasten the medical community's adoption of other forms of IT, including EHRs.
"I'm living that dream right now," said Daniel LeGrand, a vascular surgeon and chief medical officer at St. Vincent Hospital in Indianapolis. "I'm part of a group of cardiac surgeons and I'm seeing that happening as this group learns about online peer review."
LeGrand said physicians who previously weren't impressed or involved with IT were expressing more interest after getting comfortable with the online peer review process.
"Once you taste that forbidden fruit and you find out the barriers aren't as bad as you thought they were, you're definitely more willing to look at other IT possibilities," LeGrand said.
New Software Streamlines Review Process
Physicians must meet national and regional performance standards to practice medicine and perform surgery in hospitals. It's generally understood and accepted that the only people capable of assessing a physician's work are other physicians trained and practicing in the same discipline.
As the push for more transparency and accountability leads to new federal and state scrutiny of medical errors, peer review takes on new significance.
Physician peer review is "historically time consuming and inefficient based on the paper records system," LeGrand said, adding, "But that's definitely not the case with this system."
In the spring of this year, St. Vincent Hospital became one of the first in the country to try a peer review software system from a two-year-old company in California. The Clinical Review Software Suite from Acesis uses Adobe technology to allow institutions to customize the review process for medical specialty. Online delivery allows physicians to participate anytime, anywhere.
"The challenge with a lot of new technology, including EHRs, is that it slows physicians down," said Acesis CEO Kevin Chesney. "I don't think that will be the case with this. In fact I think it will be the opposite," he said.
"The early indications we're getting, working with early customers and hearing feedback from groups like Forrester Research and the Leapfrog Group, are that adoption can move much faster with this," Chesney said, adding, "We'll have to wait and see but I think the potential is really there."
'Incredibly Complex'
Chesney, whose background is in financial software, said the complexity involved in physician peer reviews with national, regional, state and institutional considerations required a new way of thinking.
"We thought we could come into this with a one-size-fits-all approach but we pretty quickly realized that wasn't going to work," Chesney said. "We have experience in transferring manual, paper-based procedures to software but the magnitude of complexity in health care is significantly higher. All the variables and the need for customization make it incredibly complex," he said.
Privacy and data security have been a major stumbling block for electronic record-keeping in health care. Chesney said the Acesis process ensures security and confidentiality requirements of the HIPAA medical privacy rule "and then some," Chesney added.
"We have the strictest password access and every time a review is opened for any reason, that entrance is tracked and audited, so we would always know a document's history," Chesney said.
"Also, Adobe has learned how to fully encrypt a document and make it safe, even if it's mailed through the Internet," Chesney said.
Only One So Far
As far as Chesney knows, Acesis is the only software company offering an online physician peer review product.
Forrester Research, an independent technology and market research company, showcased physician peer review software at its annual IT forum in May in Las Vegas. Forrester pointed to the software as an example of a product designed for intuitive use, as well as for customized applications and the ability to change and adapt for specific situations.
"Once the system is set up and all the moving pieces are in the right places, the whole procedure is much easier and more reliable than paper," said LeGrand.
"I'm from the classic school of hut and peckers," LeGrand said, adding, "Never learned to type and how to use a keyboard like people do now growing up. But I'm getting there. With this system, I'm finding that if I immerse myself in the electronic versions of peer review, it all works faster and more efficiently. Plus there's the added advantage -- and it's an important one for busy people -- that three or four people can work on the review at the same time from anywhere in the country."
LeGrand predicts the medical community, like the rest of our culture, will eventually embrace the digital way of doing things.
"We're all looking for technologies that make our lives better, that make us more efficient and give us more time," LeGrand said, adding, "I don't think there's any question we're headed for a paperless society, eventually. Systems like this might help some of us get there quicker."