Vendor Credentialing: Good Idea – Bad Execution

A few days ago I received a call from an ITAC Health member about a memo he received from a major Toronto area hospital system. The memo stated that as of a certain date all vendor sales and service personnel entering hospital facilities must produce credentials confirming that they have undergone a criminal record and vulnerable person’s check, been immunized for flu and other communicable diseases, received privacy, health and safety training, provide evidence that they have reviewed the hospitals health and safety polices and other requirements. In addition, the companies employing those reps must demonstrate that they have adequate insurance, are in good standing with WSIB, and have no outstanding Ministry of Labour fines, liens or judgements.

The hospital system had entered into an arrangement with a company that provides credentialing services. There is no cost to the hospital for this service but each vendor representative must pay $150 or $250 (depending on level of access) per year for their vendor credentials. So far only a handful of hospitals in the Toronto and Montreal areas have implemented vendor-credentialing programs. However, the trend is expected to increase as hospitals strive to reduce patient safety risk.

On the surface, the requirements don’t seem unreasonable. It’s fair to think that companies should be able to demonstrate to customers that their representatives pose no undue risk to patients undergoing treatment in hospital facilities. Credentialing works both ways. It can protect both the patient and vendor rep. The issue isn’t what, but how. ITAC Health has been following this issue for more than a year and is working with other associations, notably MEDEC (medical device manufacturers) and Rx&D (research pharmaceutical companies) to develop a strategy that works for both hospital and vendor.

The move towards vendor credentialing began more than a decade ago in the United States. A haphazard approach to implementing credentialing programs has resulted in a half dozen private credentialing companies applying different standards across a large number of hospital institutions in the US. According to the Coalition for Best Practices in HCIR (Health Care Industry Representative) Requirements, this has resulted in:

  1. Diverse and onerous requirements that can create delays in HCIR access to patient care areas.
  2. Disruptions in normal business process flow due to service personnel being denied access as a result of inconsistencies between the HCO (Health Care Organization) and the HCIR employer’s requirements/limitations.
  3. Increased costs that are estimated to add close to $1 billion per year in health care costs. Much of the cost is attributed to labour, spent in an effort to assure compliance by both the HCO and the HCIR employer due to a lack of consistency and standardization.
  4. Inconsistency in requirements, such as safety codes and operating room processes, that can create confusion leading to errors.

Even though only a handful of Canadian healthcare organizations have adopted vendor-credentialing programs to date, we are starting to see inconsistencies in scope and the criteria applied in different hospitals. Unless we take care we risk going down the same path as the US towards confusing, costly and largely ineffective programs.

Canada has already moved to address the need for vendor-credentialing, while avoiding the negative impacts experienced in the US. The Healthcare Supply Chain Network (HSCN) has established a national standard for vendor-credentialing that was developed by hospitals and vendors from across Canada. In fact, the US Coalition for Best Practices in HCIR Requirements is looking at the HSCN standard as a model for vendor-credentialing in the US.

The HSCN standard is a balanced approach to vendor-credentialing. The standard sets a reasonable but high bar on background checks, immunizations and training that is based on actual risk to patients and healthcare organizations. The standard states that “Vendor credentialing requirements should be consistent with the expectations placed on the general public for visits to public areas of the HCO, and with the HCOs’ own staff for entering restricted areas of the facility.”

The standard defines three categories of HCIR and has progressively stricter requirements based on risk:

Category I – HCIR Guest – HCIRs who may seek to call on an HCO facility, but do not provide technical assistance, do not operate equipment, do not enter patient care or clinical areas and do not provide assistance to, or consult with patient care staff or clinicians.

Category II – Tech Support and Sales HCIR – HCIRs who seek to call on patient care environments including sterile or restricted areas.

Category III – Clinical Support and Sales HCIR – HCIRs who seek to call on patient care environments including sterile or restricted areas. Such HCIRs may be required to assist in the OR, Cath Lab, Interventional Radiology or the Medical Device Reprocessing Department.

Vendors who comply with the HSCN standard will complete an attestation letter and can register their compliance on the HSCN website. Healthcare organizations that endorse the HSCN standard can also register on the website. To date all healthcare facilities in British Columbia and a large number of Ontario hospitals have endorsed the standard.

In healthcare, “doing it right” is more important than “doing it”. As is the case with so many aspects of Health IT, standardization is a critical factor for success. The HSCN vendor-credentialing standard is the right way to protect the safety of patients and vendor reps alike.

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