Members Only | 09.03.20
Digital Credentials: Pandemic and Beyond
By Michael Dugan, MBA
The COVID-19 pandemic has focused a bright light on frontline healthcare professionals around the world and given them a much-deserved level of respect and appreciation. It is important for those of us in the credentialing and regulatory world to be mindful of how we can support these workers during this time and beyond.
Challenges encountered during the pandemic include quickly and safely mobilizing a clinical workforce while taking temporary licensure rules and regulations into account. FSMB has dedicated resources to providing a concise list of licensure modifications and assisting with data needs for organizations trying to quickly vet providers. In this article, I discuss these efforts in more detail and how we see technologies we have previously discussed in NAMSS forums, such as digital credentials, play an important role now and in the future.
Background: Digital Credentials Research
Several years ago, discussion of blockchain technology and how it will change the world seemed to be part of daily conversation. This prompted research for us at FSMB in part to educate our member licensing boards, but also to see if the FSMB’s daily operations could benefit from it. In order to make sure that our comprehensive evaluation was complete, we compared the functionality of multiple technologies to ensure each met compliance, legal, security, and usability requirements. I encourage everyone to visit FSMB’s website to view the full research paper, but for now I’ll jump to the punchline.
We concluded that certificate-based digital signatures are the best first step as part of an evolutionary approach for FSMB. An additional key takeaway for us was that “recipient ownership” of documents is required to reduce redundancy during licensing and credentialing. In particular, we think this technology plays an important role for credentialing information that is static once completed but is verified many times throughout a career. Training and education credentials are good examples.
After coming to this conclusion, our first step was to implement the technology in our “closed program” repository of graduate medical education (GME) records held for programs that have shut down. This solution would be even more impactful thanks to what was then the recently developed VGMET form. Because the VGMET form was developed by and met the requirements of The Joint Commission, NAMSS, ACGME, and the American Hospital Association, it would be universally accepted and allowed us to create a list of standard data fields when working with programs.
We named the process “Lifetime Credentials” to acknowledge that, if maintained properly, these credentials would not need to be reissued or physically reverified by the issuing institution.
Real Life: Hahnemann University Hospital
Initial adoption of Lifetime Credentials required us to strengthen our use of digital certificates and to add document functions to our systems. We were well on our way to implementing our solutions when we were contacted by Hahnemann University Hospital (HUH) in summer 2019. What is now widely documented, HUH was in the process of closing and needed to take steps to preserve the records of their current and former residents.
Not only was HUH large by any standard (i.e., number of programs, number of residents), it also was one of the longest standing residency programs in the country. Retaining this many paper records to keep on file “just in case” they needed to be accessed was not a viable option for FSMB. Therefore, we worked closely and quickly with HUH staff to create data-based extracts of the VGMET standard in order to produce digitally signed versions that could be delivered to graduates of HUH residency programs.
Because of the newness of this solution and because the concept of accepting documents directly from physicians is counter to years, even decades, of accepted processes, we took several steps to assist in the acceptance of these documents. First, each document has a cover sheet that acts as a verification instruction sheet for the document. Second, we added a verification step that is not inherent when using certificates alone. When documents are signed, a digital hash is created. This hash is essentially a fingerprint for each document. This means that in addition to the blue-ribbon certificate signature available with each document, there is a second way to verify the authenticity of the document at certs.fsmb.org. Lastly, we held instructional sessions on the use of the documents for licensing boards and others.
The final statistics for the HUH project were 5,863 records for individuals across 35 programs and 39 years (1980–2019). We were excited to make this solution available to those impacted by the HUH closure. Having the ability to verify the source of a document, even if the institution has been closed, adds value to physicians and those who need the documents (hospitals, boards, etc.). It also begs the question: Why not use a similar tool for active programs?
Pandemic Work: USMLE Transcripts
Like most organizations, the FSMB has made several changes in response to the COVID-19 pandemic to implement working procedures that complied with shelter-in-place policies, work-from-home practices, and physical distancing guidelines. One immediate area impacted by change was the printing by the FSMB of United States Medical Licensing Exam (USMLE) transcripts. These transcripts are a critical component of the medical licensing process. Prior to the pandemic, these transcripts were made available in electronic format (via our Federation Credentials Verification Service, or FCVS) and in printed form in a usage pattern like that of most medical school transcripts.
Because the provision of printed transcripts requires physical action to both print and mail them, a special procedure was required outside of our work-from-home guidelines. FSMB had previously discussed the applicability and possibility of Lifetime Credentials to USMLE transcripts, but we did not have a scheduled implementation date. After assessing the needs and the severity of the situation, we decided to promptly move forward and began issuing final USMLE transcripts with our Lifetime Credentials process during the pandemic.
After a short implementation and testing window, the process was formally put into place and use of these documents has since been well received by many stakeholders.
Pandemic Work: Helping Match Physicians
Our data response to the pandemic included quickly taking action to provide open access to FSMB’s Physician Data Center (PDC), our physician profile tool, at no cost. This temporary step removes a barrier to institutions, such as departments of health and health systems, that need to quickly verify the credentials of a large number of physicians.
Additionally, we worked directly with several state agencies and other organizations faced with challenges matching the identity of individuals who were on volunteer lists. In some cases, these lists were built with incomplete data because collection methods were created quickly in response to the pandemic. The FSMB was able to use automated processes to match a large percentage of practitioner records, but some required many hours of manual matching to provide the requested information.
This work plainly illustrated that a better and more commonly used set of identifiers would benefit providers, agencies, and regulators by improving data exchange in emergency situations such as a pandemic.
The Road Ahead: HRSA Grant
The need to quickly vet healthcare providers to assist heavily impacted areas was readily apparent during the early stages of the COVID-19 pandemic. Through the work described in this
article, we saw an opportunity to help in the future.
Our vision is for a tool that can be used by providers as well as agencies and other healthcare organizations. Functions for providers will include registering and marking themselves as available to assist in a geographic area. We also see allowing them to download an authenticated summary document that shows the status of the licenses they hold, high-level specialty information, and disciplinary history. Unlike a Lifetime Credential, this document will be clearly marked as being time bound for authenticity. This workflow will allow simple verification without third-party involvement. This type of functionality could have saved much time and effort during the first wave of the pandemic.
In addition to provider functionality, we envision a portal that will allow qualified institutions to easily match their lists of providers against the appropriate data sources. Functions also can be provided that allow searching for pre-qualified clinicians who have volunteered, and providers with disciplinary history can be flagged via clear and prominent visual notes.
After proposing our idea to the Health Resources and Services Administration (HRSA) as part of their work regarding license portability, they agreed that such a tool is needed and will be supporting its development through grant funding.
Our daily work at FSMB is focused on physicians and physician assistants; however, we will be working with our peers across healthcare regulation to include as many professions as possible to participate in the use of this tool. As our work progresses, we look forward to discussing it as broadly as possible with regulators, MSPs, and healthcare organizations.
Michael Duganis the COO of the Federation of State Medical Boards (FSMB). Mike has been with FSMB since June 2010. He received a bachelor’s degree from The Ohio State University and a Master of Business Administration from Southern Methodist University. He has over 25 years of healthcare information technology (IT) and operations experience.