Frequently Asked Questions
Who is Columbia Healthcare Analytics, Inc.?
Columbia Healthcare Analytics is a California-based corporation that functions as a mission-based organization, such as Newman’s Own Food Brand, through which profits are channeled to build peer review networks to improve patient care and lower healthcare costs. Newman’s Own has produced over $400,000,000 for charity. Our revenue goes toward development of a national platform to conduct peer review for all healthcare services and create employment opportunities for underemployed Americans. CHA’s product is External Review as a Service (ERaaS™) which enables physicians and hospitals to perform standardized review for facilities other than their own and to provide objective, critical and educational review.
Why is CHA’s Approach Unique and More Effective than any other internal or external review process?
CHA’s ERaS™ overcomes all aspects of internal peer review that make internal review inherently and universally ineffective:
Internal review is susceptible to reviewer bias because physicians cannot commonly review hospital colleagues objectively due to social, political and economic relationships among hospital physicians.
Internal review commonly is primarily based upon laboratory value algorithms, that do not factor other clinical aspects of patient care, nor does it permit simultaneous review of non-transfusion patient blood management strategies, nor does it permit simultaneous review of non-patient blood management services, such as anesthesia, surgery, critical care, other medical management and diagnostic services. Transfusion algorithms and CPOE primarily based on laboratory values are not highly effective in excluding numerous seemingly appropriate transfusions.
To effect immediate and rapid change, hospitals optimally must perform 100 percent chart review, which is beyond the capability of virtually all organizations.
Internal review “benchmarks” do not identify specific errors made during patient care or mentor physicians about how to provide better patient care.
Internal review does not permit rapid consensus building or easily adjudicate patient care issues through outside experts. Hospitals may at time lack sufficient patient care expertise necessary for internal review.
Internal review is not performed in a standardized, controlled manner, and consequently inter-institutional comparison is not possible.
Physicians and hospital staff generally do not like performing chart review.
Finally, internal review is inherently adversarial and not educational.
Can review be performed with Epic, Cerner or any EHR vendor? Do you require a specific vendor?
Yes, review can be performed with any EHR vendor.
We don’t have a single Electronic Health Record. Can the review be performed if data is partitioned between two or more information sources?
Review can be performed if health records are performed if data is stored on more than one information system.
Some of our records are stored as paper documents. Can review be performed from paper records?
Review can be performed using paper records with no work required of hospital staff. There is no requirement for an EHR or requirement for hospitals to scan documents or enter data.
Is there a need to interface with hospital information systems?
No. CHA only needs access to document images.
How much extra work is required by hospital staff?
We perform virtually all work. Once we have access to chart records there is little for hospital staff to do. There is no document handling or data entry required of hospital staff.
What is the Return on Investment?
Review should generate an immediate improvement of 5 to 15 percent upon commencement of review, generating an immediate ROI. The first year annual ROI should be 5 or higher.
What is the cost for chart review?
The first 100 charts are billed at $390 per chart. Subsequent charts are billed at $190 per chart. Small additional fees of $30 to $60 are charged for special peer review covering review of special services. In rare circumstances additional fees may be higher in extraordinary situations.
Is review compliant with HIPAA?
Yes. All identifiers are redacted.
Does review evaluate just RBC use?
No. The appropriateness of all blood components are individually reviewed, including all plasma, platelet and cryoprecipitate use, in addition to RBC use.
Do you look at other aspects of Patient Blood Management besides appropriateness of blood use?
We evaluate any aspect of Patient Blood Management and Transfusion: consent, transfusion documentation, adverse events, pharmaceutical management, diagnostic testing, etc.
Can you review services other than blood use?
Yes, we can evaluate any diagnostic or therapeutic service(s).
What criteria are used to assess appropriate blood use and other hospital services?
We factor all relevant clinical and laboratory data to assess appropriateness of blood use. Decisions about blood use are not based primarily upon laboratory criteria.
How long does it take to implement chart review?
Chart review can beginning within days of granting access to medical charts. Because there is little for a hospital to do other than provide access to its medical record, we are able to begin review and improve physician practice more rapidly than any other quality improvement program.
How long does it take to get a chart review findings back to the hospital?
Review findings can be returned to the hospital within days of chart access. Most hospitals choose to receive reviews monthly, so the turnaround time for one month’s review is 30 days.
How quickly can physician behavior be improved?
Physician improvement should occur immediately as a consequence of the Hawthorne Effect once physicians are aware that 100 percent ongoing chart review is occurring.
Do we need a physician champion?
A physician champion is not necessary, however the administration and medical staff must be committed to high quality patient care.
Who performs chart review?
Physicians with subject matter expertise review charts. Chart review is not performed by non-physicians or by computers.
Can you track blood use by physician?
Yes.
How is feedback provided to physicians?
Case management summaries are delivered directly to physicians in an electronic format.
How do physicians respond to chart review comments?
Physicians respond favorably to review comments because conclusions are well substantiated and feedback is designed to mentor physicians using actual case management as an educational tool.
What are the next steps to begin a review?
We provide live demonstrations of our review platform and will submit a Statement of Work. Once a signed SOW and deposit is received, we can immediately begin work once the hospital’s Business Associate agreement is signed and access to medical records is granted.