Wanted: Emergency credentialing

By John Pulley
01:00 AM

In the immediate aftermath of hurricanes Katrina and Rita, the devastated Gulf Coast region attracted the selfless and the self-serving.

Most of the men and women who ventured into the devastated region had come to help. Looters, outlaws, opportunists and profiteers showed up to help themselves.

The latter group included medical workers of dubious credibility ? mostly doctors who had been stripped of licenses as a result of drug abuse, incompetence or worse. Hurricane survivors, battered by one of the country's worst natural disasters, were vulnerable to being further victimized.

The inability of officials to easily distinguish credible practitioners from impostors exposed cracks in the patchwork system for verifying the credentials and qualifications of medical professionals.

"In Katrina, like [the terrorist attacks], the folks we heard from first were the people whose licenses had been revoked," said Dale Austin, senior vice president and chief operating officer at the Federation of State Medical Boards (FSMB), speaking at a medical credentialing briefing in Washington, D.C., in May. "They were looking for the opportunity to right the wrong [that had resulted in their licenses being revoked]?or to gain access to patients or to gain access to drugs."

A number of initiatives are under way to fix the system. The Department of Health and Human Services is working to create the Emergency System for Advance Registration of Volunteer Health Professionals, a national network of state-owned systems for verifying the credentials of medical professionals. To date, 13 states have systems operating with varying degrees of proficiency.

The challenge is to create universal standards that will make possible the creation of an interoperable credential that legitimate health care workers can use in an emergency to quickly verify their identities. HHS is working on the third draft of guidelines intended to establish uniformity across state systems.

Achieving the vision of a seamless and comprehensive verification system will depend in large part on interagency communication and cooperation, Austin said.

The absence of such a system was apparent in the Gulf Coast region last year. Hurricanes Katrina and Rita hobbled much of the local health care infrastructure, and the Louisiana State Board of Medical Examiners was out of commission for six weeks. When the board's Web site went down, hospitals and clinics lost the primary means by which they certified physicians' licensure.

FSMB set up ad hoc systems that verified 1,200 doctors' licenses in that six-week period. The Department of Veterans Affairs and the Veterans Health Administration helped as well, using its VetPro database to confirm the qualifications of doctors in its system. VetPro is based on a three-tier architecture that uses optical, data and Web servers.

The temporary system helped stem the tide of "impostor physicians and doctors with significant disciplinary histories [who] began showing up at hospitals and clinics," according to an account published by FSMB.

Too often, however, verification took days instead of hours. One possible solution could lie in a $2 billion project for providing federal workers with biometric-equipped smart ID cards, said Tony Cieri, principal consultant for the Homeland Security Department's First Responder Partnership Initiative. That system could prove useful for establishing health professionals' credentials in an emergency.

A recent test of DHS' initiative assessed the use of smart cards, handheld electronic readers and other technology, said Craig Wilson, program coordinator of the DHS initiative.

The exercise sought to document the arrival of 285 first responders at a designated location. It logged 206 successes and 79 failures. The culprit? People forgot their personal identification numbers.

Pulley is a freelance writer based in Arlington, Va.