The World of Credentialing and Medical Services Over the Past 50 Years

This blog post is based on an industry insight webinar - Emerging Trends: The Impact of Technology, COVID-19, and Other Factors on Credentialing and Medical Services; presented by Vicki Searcy and Lisa Rothmuller.

It comes as no surprise that a lot has changed in the world of credentialing and medical services over the past 50 years. The robust offering of software and technology that facilitates our industry today is unparalleled—in fact, it’s changed the way the industry functions as a whole. But...how did it all start?

In the beginning

It all started in the late 1970’s with the advent of a new profession: Medical Staff Secretaries. The center of this new profession was California, where the National Association Medical Staff Services (NAMSS) was formed, with Articles of Incorporation filed in 1978. These Medical Staff Secretaries were responsible for administrative tasks, accreditation, and licensing, and they served as a liaison between physicians and the organization’s administrative office.

To be a successful Medical Staff Secretary, one needed to possess certain qualifications:

• Secretarial and clerical organizational skills
• Typing (at least 60wpm)
• Shorthand was a plus for taking minutes
• “People” skills to work effectively with physicians
• Ability to self-manage workload
• Willingness to learn accreditation and licensing standards

Back then, the Medical Staff Secretary’s scope of service was primarily focused on credentialing rather than privileging, with an emphasis on applicant reputation versus current clinical competency (that came later), and a spotlight on application content and necessary verification procedures. In those early years, profiles for reappointment were needed to meet requirements set forth by The Joint Commission, and they were almost always the responsibility of the Medical Staff Office. This required verification of:

• Citizenship
• Volume of clinical activity
• Category inclusion requirements
• Number of medical record suspensions

Medical Staff Secretaries were responsible for a variety of tasks that kept the medical facility running, up to date, and organized:

• Meetings
  • Coordinate meetings
  • Take minutes, necessary for official documentation of staff activity and rationale
  • Often included involvement in peer review activities in order to document results and follow-up
• Governance Documents
  • Maintain documents to ensure the organization was current with accreditation requirements, including:
    • Medical staff bylaws
    • Rules and regulations
    • Policies and procedures

There were also some additional, more discrete tasks that Medical Staff Secretaries were responsible for including creating and sharing ER call lists, managing physician referrals for patients, and overseeing calendars and special events.

And then technology hit the scene

In the mid 1980s we started seeing some technological improvements with the introduction of limited computer software (typically proprietary to a medical institution) and the use of spreadsheets. However, this was still rare. At this point, most organizations stuck to using typewriters, rolodexes, photocopiers, had columns of filing cabinets, and used only snail mail to get paperwork completed. Though it’s hard to imagine today, these were the days before the Internet was here to make everything more immediate, attainable, and easy to navigate.

However, there were some software solutions coming out back then that certainly had an impact on the creation of the robust offerings we see today. Early credentialing software was created mostly to produce rosters and other lists, organize information by specialty, licenses and expirations dates, and manage reappointments. This technology was able to “automate” credentialing by merging information from a database into other documents, and it gave organizations the ability to track attendance at meetings. Though limited, this was still an improvement.

It wasn’t until the late 1990s and early 2000s, with the emergence of The National Committee for Quality Assurance (NCQA) and Credentialing Verification Organizations (CVOs), that the industry really started to embrace technology and grow into what it is today. The need to have data available within an organization, that was accessible cross-departmentally, became crucial. Those needs, coupled with ongoing technological advances are what led us to the way we look at credentialing and privileging today, which you can learn more about in part 2 of this post: The Impact of Technology and COVID-19 on Credentialing and Medical Services