Beth and Rick,
Proceed with great caution before using a VR-integrated peer review system unless
- The radiology group is actually employed by the hospital; or,
- The radiology group owns and controls the VR dictation system and uses it to provide reports to the hospital.
If you are an independent group who uses the hospital's VR system be very careful. You may end up enabling plaintiff's attorneys to pierce the (normally) protected status of the peer review details. I copied an RBMA Forum post I wrote in 2019 below in which I detailed my original concerns and what our (very experienced) healthcare attorney told us. In the end, we simply could not use the hospital's VR system in the way we had hoped. What we ended up doing was using the VR system to prompt the radiologists to perform a read, but only record normal in the VR system. If a discrepancy is identified, we skip that review on the VR system then log into RadPeer to record the discrepancy. Because RadPeer removes all identifying date (including comments and radiologist names), and because RadPeer is strictly accessible by our Peer Review committee and no one else, it remains undiscoverable. Again, if you own and control the VR system, this shouldn't be a problem. But if the hospital owns/controls it, there are many people within the institution and who are not members of your peer review committee that will have access to the results, killing one of the key tenets of the non-discovery rules. Proceed with extreme caution and seek good legal advice (not from the hospital).
MBohl
____________________________________
From: mbohl@rgimaging.com
Sent: Tuesday, May 28, 2019 10:33 AM
To: RBMA-practicemanagement@ConnectedCommunity
Subject: Use of VR Systems to Perform/Record Peer Review: Does This Provide Plaintiff's Attorneys an Opportunity to Pierce Peer Review Protection Laws?
Here is a situation for forum members to consider:
Do you use your hospital's Voice Recognition (VR) system's built-in peer review capabilities to identify studies for peer review?
- Do you your hospital's VR's system to track and report the peer review outcomes?
- Do you expect this information to be protected from discovery by plaintiff's attorneys under your state's peer review protections?
If you answered "Yes" to these questions you may want to seek legal advice about the wisdom of continuing to use your hospital's VR system to perform peer review. I'll explain why.
We had used RadPeer for many years. We were in control of RadPeer and its reports. Not only that, RadPeer deletes all extraneous information which makes it impossible to retrospectively identify whether or not any specific study was reviewed or when. Not only that, as long as we shared this information only within the peer review committee we felt secure our process was protected by our state's peer review protection statutes and exempt from legal discovery.
I was excited to learn that the VR system the hospital was installing would randomly select studies for review and present them to the radiologist. This would have removed two of the biggest obstacles for our use of RadPeer – getting all our radiologists to perform peer review (Instead of the few who tended to do it), and randomization of the selection process. However, I was concerned about discovery, and had a few questions which revolved around what happens with the data, not the least of which were:
- Was the study that was reviewed marked in some way so the system knew it had been reviewed;
- Were the results deleted or de-identified;
- Could the results be tied back to a specific radiologist; and
- Who had access to the information?
It seemed to me that the way the system worked it had to maintain a record of which studies were reviewed and who reviewed them – this was the only way the system could randomly select studies across radiologists, modalities, and sites, and be sure to not reselect them. If this was the case, this meant that the data concerning any specific radiologist (or all of them) could be reproduced. It also meant that, if litigation occurred, it would be possible to learn if any of the study(ies) in question had been peer reviewed earlier. What I found was that this would be entirely possible.
The issue then turned to discovery. From my understanding, the peer review process has strong protections against use in litigation as long as the data is kept within the peer review committee. When I looked at who had access to the intra-VR peer review results I found exactly what I expected to find: Several people within the institution had access to the peer review module and reports, e.g., the top level system administration, several people in IT, the radiology department managers, the head of HIM (transcription), etc. It is, in fact, their system, not ours. Worse, it was literally impossible to set the system to allow only peer review committee members access. After all, IT and others in the organization are certainly going to have access to a piece of critical infrastructure.
I had many discussions with the vendor. Their initial response was that no one had ever raised the issue, but they'd look into it. In the end, they admitted the data (which studies were reviewed, the rad who read the study initially, who performed the peer review, and the review's outcomes) are recorded and maintained within the system, and are never deleted.
I then contacted one of our healthcare attorneys who , after looking at the facts and circumstances, advised us (really point blank told us) to not use the VR system: It exposed us to having to produce this information during discovery if asked to do so primarily because 1) the data was not deleted; and 2) the reports are available to people outside the peer review committee.
In the end, we felt we could not use the VR system's peer review module to perform peer review due to the threat of having our peer review protections pierced so we continue to use RadPeer to perform and record our peer review results. If the radiology group owned and controlled the system the decision may very well have been different as we could easily control who has access, but we don't. If you are using your facility's VR system to select and record your peer review data you may want to look into this and see if your system maintains the data and whether or not people outside the peer review committee have access to the results. Perhaps your attorneys come to a different conclusion.
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Michael Bohl FRBMA
Strategic Advisor
Radiology Group, PC, SC
Bettendorf IA
(563) 484-0488
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Original Message:
Sent: 08-24-2020 07:18
From: Rick Sylvanus
Subject: Peer Review
Thanks Beth!
Reposting the question in hopes of other responses:
Is anyone using a radiologist peer review program other than ACR radpeer, for instance the integrated peer review with Philips Intellispace PACS? If so, what are the issues with using that data while obtaining ACR accreditation?
Original Message:
Sent: 8/16/2020 11:30:00 PM
From: Beth Williams
Subject: RE: Peer Review
Hi Rick -Yes , my practice uses a proprietary peer review program that is neither ACR Radpeer, or one of the health systems pacs packages. The reason is we wanted the data to span multiple health systems, and we wanted the results not to be visible to the health systems pacs analysts. We also wanted the ability to trend and analyze the data across multiple health systems by provider.
ACR Radpeer accepts an export from our proprietary tool so we are still able to see national results.
We are also able to accept exports from the hospitals pacs system if the radiologists are required to participate in those peer review processes.
The proprietary system leverages the Powerscribe custom fields when the radiologists dictate and exports that data via our report feed. (Its separate data and we limit this to peer review agree cases.) Otherwise radiologists access the web tool for disagrees.
The tool isn't available commercially, but was also relatively easy to set up, and allowed us to leverage HL7 feeds, and randomize the cases to subspecialty and monitor adherence to budgeted volumes of review.
Hope that helps,
------------------------------
Beth Williams MHA, FACMPE, FRBMA
Executive Director
Vantage Radiology and Diagnostic Services
Federal Way WA
(253) 661-1700 ext. 1105
Original Message:
Sent: 08-16-2020 06:14
From: Rick Sylvanus
Subject: Peer Review
Forum,
Is anyone using a radiologist peer review program other than ACR radpeer, for instance the integrated peer review with Philips Intellispace PACS? If so, what are the issues with using that data while obtaining ACR accreditation?
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