Oregon Searches for Solutions to Credentialing of Physicians Providing Telemedicine Services

08/21/13  Networked Oregon

By Catherine Britain, Staff Writer for The Northwest Regional Telehealth Resource Center.

When Dr. Miles Ellenby first began providing care via telemedicine, he was excited at the prospect of caring for children throughout the state without always having to transport them to Doernbecher Children’s Hospital at Oregon Health and Sciences University (OHSU) where he is an Associate Professor of Pediatric Critical Care. He soon learned that one of the biggest barriers to delivering telehealth services around the state was that of credentialing his team. He discovered that each site required different credentialing documents and that some, like proof of a current TB test, were not pertinent to providing the services. Because of the different requirements at different hospitals, the process of credentialing physicians to practice telemedicine was a huge undertaking even for a very large institution like OHSU. As the Medical Director of OHSU’s telemedicine program, his frustration continued to grow when in May of 2010 OHSU launched a large expansion of the telemedicine program and at the same time many of his team were up for re-credentialing. He believed that the burden of increased resources necessary to complete each credentialing process threatened to significantly slow if not halt, the planned growth of OHSU’s telemedicine program.

Coincidentally during May of 2012, Dr. Ellenby, while on his way to New Orleans, found himself seated next to Oregon State Senator Elizabeth Steiner Hayward. In addition to being a State Senator, Steiner Hayward is a family physician at OHSU and a colleague of Dr. Ellenby’s. The Senator asked Dr. Ellenby to describe the biggest challenge for moving telemedicine forward in Oregon. After discussing the difficulties with credentialing Senator Steiner Hayward offered to help by sponsoring legislation that would streamline the credentialing process for physicians who practiced telemedically. Dr. Ellenby set to work with Mark Lovgren, Director of Telehealth Services at OHSU, and the OHSU legislative team to assist Senator Steiner Hayward to draft a legislative concept. They met with representatives from originating and distant site hospitals in both urban and rural areas in order to understand and deal with their concerns regarding a streamlined process for credentialing. They learned that originating sites were concerned about maintaining the autonomy of their governing boards and their liability if any, if they accepted the physician credentials of the distal site. They also wanted a role in determining what kinds of documentation to include and not include in the credentialing documentation. Senate Bill 569 reflects their efforts to respect the autonomy of the governing boards and streamline the process at the same time.

SB 569 was passed out of the Legislature on May 30, 2013, and signed by the Governor. The main points of the legislation are:

SECTION 2. (1) The Oregon Health Authority shall prescribe by rule the information and documents that a governing body of an originating-site hospital may request for credentialing a telemedicine provider located at a distant-site hospital.

(2) The rules adopted by the authority under subsection (1) of this section must:

(a) Prescribe a standard list of information and documents that shall be provided by a distant-site hospital;

(b) Prescribe a list of information and documents that may be requested by an originating-site hospital in addition to the standard list of information and documents;

(c) Prescribe a list of information and documents that may not be requested by an originating-site hospital; and

(d) Be consistent with all applicable legal and accreditation requirements of an originating-site hospital and the health plans with which the originating-site hospital contracts.

(3) Except as provided in subsection (4) of this section, an originating-site hospital in this state must comply with the rules adopted under this section if the telemedicine provider is located at a distant-site hospital that is located in this state. This section does not prevent hospitals located outside of this state from using or require such hospitals to use the prescribed list of information and documents in credentialing a telemedicine provider.

(4) An originating-site hospital is not limited to the information and documents prescribed by the authority if the originating-site hospital has a delegated credentialing agreement with the distant-site hospital where the telemedicine provider is located and the governing body of the originating-site hospital accepts the recommendation of the medical staff to credential the telemedicine provider.

(5) In the adoption of the rules described in subsections (1) and (2) of this section, the authority shall consult with representatives of distant-site hospitals and originating-site hospitals in this state. Once adopted, the authority may not amend the rules to alter the prescribed lists without first consulting representatives of distant-site hospitals and originating-site hospitals in this state.

(6) This section does not affect the responsibilities of a governing body under ORS 441.055 and does not require a governing body of a hospital to grant privileges to a telemedicine provider.

The Oregon Health Authority will appoint a workgroup to develop the standardized list of information and documents required for credentialing a physician practicing telemedically. Once the list has been developed much work will need to be done with the originating site governing boards to understand what is required and to help them make the necessary changes, if needed, in their medical staff by-laws.

In an interesting aside, Senate Bill 604 was also passed unanimously by the Legislature during the final week of the session. SB 604 requires the Oregon Health Authority to establish an electronic database for the purpose of providing to credentialing organizations access to information that is necessary to credential or re-credential health care practitioners.

Regardless of which bill takes precedence for telemedicine it would appear that the process of credentialing for Dr. Ellenby and his peers throughout Oregon will become more standardized. Through the collaborative efforts of all involved, undoubtedly the credentialing process will become more streamlined and efficient.

More information on the bills and their implementation will be available soon on the Telehealth Alliance of Oregon website.