Interactive External Utilization Review (IEUR)

How Does Interactive External Utilization Review Work?

CHA provides all work related to utilization review. Any activities that healthcare organizations currently perform to handle UR is eliminated, freeing up hospital staff to work on other more productive projects.

These are the steps to our process:

• Data from paper or electronic medical records is uploaded to a remote site using the most secure encryption technology available.
• All patient protected healthcare information and proper names of the institution, physicians and geography are masked through a proprietary process. Redaction of identifying information assures that any person subsequently viewing any document will not be able to identify the geographic source, hospital or patient chart from which the information has been obtained.
• Relevant data is then captured from the patient chart documents in order to create a Patient Case Sheet (PCS) that lists all of the pertinent clinical variables required to critique healthcare delivery. This condensed presentation of the PCS permits the rapid critique of hospital services in under one minute, that otherwise could take an hour to perform if it were even possible to remember all of the information contained in the medical record. For example, the ability to rapidly assess all blood transfusions in a chart in less than one minute produces the capability to review all hospital transfusions rather than a typical, limited sample of 5% or even less.
• The Patient Case Sheets are then made available to external physician reviewers who can critique hospital services and provide direct educational feedback to the provider. The electronic format can produce quick consensus and multidisciplinary opinions about optimal patient care.
• IEUR is an educational, rather than a punitive improvement process, which monitors all aspects related to resource utilization and provides a wealth of performance data. IEUR does not replace committees, such as the transfusion practice or quality committee, but instead allows these committees to function more effectively. In the case of the transfusion committee, our service eliminates the need for chart review, which is time-consuming and non-productive with rare instances of ineffective blood use identified. The committee can now focus on UR data analysis, as well as transfusion policies and procedures.

While IEUR is successfully applied to hospital blood usage, it may be simultaneously or independently applied to monitor any resource utilization or medical staff peer review process.