This administrative project deals solely with identifying the current role(s) of the "supervising/mentoring" physician and implementing a policy that clarifies their responsibilities while supervising/mentoring Physician Assistants (PAs) and Nurse Practitioners (NPs) at Kaiser Permanente Northwest (KPNW.) The Oregon Board of Medical Examiners (BME) requires that a set number of the PAs charts be reviewed by his/her supervising physician, and that specific number is determined by the PA and their supervising physician on the PAs practice description. NPs are required to have a "collaborative relationship with other health care professionals" that is generally used for mentoring purposes KPNW utilizes NPs and PAs identically in the clinical setting, and it is therefore appropriate to institute a policy that governs both PAs and NPs. KPNW employs approximately 75 PAs throughout Oregon and Washington that all have different practice descriptions and therefore different chart review requirements. Prior to this project there was no formal system in place at KPNW that was able to accurately and efficiently document that chart review was taking place on a consistent basis.
After reviewing the current mentoring structure it was evident that BME chart review requirements were not being met. A series of meetings followed with myself, Julie Jensen (policy analyst), Ben Berger, PA-C (Affiliated Clinician (AC) director), and Ron Potts, M.D. (Assistant Regional Medical Director.) These meetings resulted in the following three objectives: Define the Physician's role in the AC/physician relationship, develop an education program for Physicians, and to demonstrate that the supervising/mentoring Physicians are reviewing AC charts. While considering the objectives stated above, three different solutions were presented to the Operations Committee for approval and resolution of the current mentoring structure. The chosen option was to modify Epic-care and include a unique "addendum identifier" that is tagged to the chart using a "order code" in the visit summary screen. The other feature being added is that of a "system phrase" that will allow a supervising physician to make comments regarding a specific chart without overriding what is currently documented. These comments in the "system phrase" are then routed back to the originating clinician for review and feedback. By adding this feature to Epic-care the process of chart review has become automated, efficient, cost effective, and meets the lawful requirements as set forth by the Oregon BME. Although the Washington BME does not have a chart review requirement, this process can also be used as a quality assurance tool for the administration, clinicians, and members of KPNW for both Oregon and Washington.
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