JCAHO Publishes New Hospital Credentialing Standards for Telemedicine
October 31, 2003
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has recently revised its hospital standards for credentialing telemedicine providers. The revised standards, effective January 1, 2004, are contained in the "Medical Staff" chapter of JCAHO’s 2004 Comprehensive Accreditation Manual for Hospitals.
Telemedicine is the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient, the education of the health care provider and for the purpose of improving patient care, treatment and service. Prior to the revisions, JCAHO required all practitioners, who diagnosed or treated patients via a telemedicine link, to be subject to the credentialing and privileging processes of the organization that receives the telemedicine services. This former standard required even indirect treatment providers such as radiologists and pathologists to be credentialed, as well as consulting physicians. Many hospitals found this standard burdensome, particularly where there are a large number of telemedicine practitioners providing services.
To reduce the credentialing and privileging burden on originating sites where the patient is located, JCAHO adopted a new standard, MS.4.120. This standard is applicable only to licensed independent practitioners (LIPs) at distant sites where the practitioner provides professional services, who have total or shared responsibility for the patient’s care, treatment and services via a telemedicine link.
The new standard requires originating sites to credential and privilege distant site telemedicine providers through one of the following three mechanisms:
- The originating site may fully privilege and credential the practitioner according to the traditional privileging and credentialing standards contained at MS.4.10 through MS.4.110.
- The practitioner may be privileged at the originating site using credentialing information from the distant site if the distant site is a JCAHO accredited organization.
- The originating site may use the credentialing and privileging information from the distant site if all the following requirements are met: the distant site is JCAHO- accredited, the practitioner is privileged at the distant site for those services to be provided at the originating site and the originating site has evidence of an internal review of the practitioner’s performance of these privileges and sends to the distant site information that is useful to assess the practitioner’s quality of care, treatment and services for use in privileging and performance improvement.
The new standards also require the medical staff at both the originating and distant sites to recommend the clinical services to be provided by LIPs through a telemedical link at their respective sites.
LIPs who provide official readings of images, tracings or specimens through a telemedicine link must be credentialed and privileged under the contracted services standard LD.3.50.
While the new telemedicine standards provide much needed clarification of JCAHO’s position with respect to credentialing and alleviate some of the burden on hospitals in performing such credentialing, hospitals should carefully consider the legal implications of using another organization’s credentialing and privileging information. For example, an originating site’s reliance on the distant site’s credentialing and privileging decisions could expose the originating site to claims of negligent credentialing. This can occur if the distant site fails to exercise reasonable care in selecting professional staff, allows an incompetent health care professional to maintain privileges or fails to monitor the ongoing competency of a staff member.
Sharing of credentialing information among hospitals in a telemedicine arrangement also creates unique privacy issues under HIPAA, namely, the ability of the distant site to disclose protected health information contained in credentialing files to the originating site. Other legal issues that should be considered include practitioner licensure, malpractice liability and reimbursement issues. With proper planning, hospitals can minimize the legal exposure of their telemedicine programs.
