Practice Management

Here is a situation for forum members to consider:

1. Do you use your hospital's Voice Recognition (VR) system's built-in peer review capabilities to identify studies for peer review?
2. Do you your hospital's VR's system to track and report the peer review outcomes?
3. 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:

1. Was the study that was reviewed marked in some way so the system knew it had been reviewed;
2. Were the results deleted or de-identified;
3. Could the results be tied back to a specific radiologist; and
4. 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 no 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.  Afterall, 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 recoded 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. 

Food for thought. 

Michael Bohl

Mike – Thanks for this information. I had just started this process with a client and feel the work is now done..... Appreciate your insights and detailed work here to assist us all.....